Feb

16

Assigning a POA indicator for diabetes that progresses from controlled to uncontrolled during a hospital stay

By HIM Connection

Q: When a patient presents with controlled diabetes that progresses to uncontrolled during a hospital stay, should we assign present on admission (POA) indicator N?

A: There is no Coding Clinic on this particular topic. However, you would presumably assign the POA indicator N because controlled diabetes is a combination code, and a portion of the code was not POA (i.e., the uncontrolled diabetes). Consider the following excerpt from the ICD-9 Official Guidelines for Coding and Reporting:  

Assign “N” if any part of the combination code was not present on admission (e.g., obstructive chronic bronchitis with acute exacerbation and the exacerbation was not present on admission; gastric ulcer that does not start bleeding until after admission; asthma patient develops status asthmaticus after admission).

Editor’s note: Shannon E. McCall, RHIA, CCS, CPC-I, director of coding and HIM at HCPro, Inc. in Chesterfield, VA, answered this question that originally appeared in the February issue of Briefings on Coding Compliance Strategies.