POA Progression of Pressure Injury

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Mike Davis
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      Thank you for your inquiry regarding CMS826, Hospital Harm - Pressure Injury.

      Regarding your first question: As was the case for CMS826v2, in CMS826v3, If a patient has a deep tissue pressure injury or stage 2, 3, 4, or unstageable pressure injury present on admission (identified either by Present on Admission (POA) indicators or skin exam), then the patient's hospitalization will meet the denominator exclusion criteria and will not be included in the measure calculation. Because this inpatient hospitalization would be excluded from the measure's denominator, the progression of this pressure injury and/or any new pressure injuries that the patient develops later in the hospitalization (either at the original pressure injury site or another site) would not qualify the patient's hospitalization for the measure's numerator. However, if the patient had a stage 1 pressure injury present on admission that worsens to a stage 2 during the hospitalization period, the inpatient hospitalization for this patient may meet the numerator criteria, as this would be considered a new stage 2 pressure injury. Inpatient hospitalizations for patients with a stage 1 pressure injury present on admission are not excluded from the measure's denominator.

      Regarding your second question: This question is out of scope for the eCQM Issue Tracker. Please submit any questions about the Hospital-Acquired Conditions (HAC) Reporting Program via QualityNet: https://cmsqualitysupport.servicenowservices.com/qnet_qa
      Show
      Thank you for your inquiry regarding CMS826, Hospital Harm - Pressure Injury. Regarding your first question: As was the case for CMS826v2, in CMS826v3, If a patient has a deep tissue pressure injury or stage 2, 3, 4, or unstageable pressure injury present on admission (identified either by Present on Admission (POA) indicators or skin exam), then the patient's hospitalization will meet the denominator exclusion criteria and will not be included in the measure calculation. Because this inpatient hospitalization would be excluded from the measure's denominator, the progression of this pressure injury and/or any new pressure injuries that the patient develops later in the hospitalization (either at the original pressure injury site or another site) would not qualify the patient's hospitalization for the measure's numerator. However, if the patient had a stage 1 pressure injury present on admission that worsens to a stage 2 during the hospitalization period, the inpatient hospitalization for this patient may meet the numerator criteria, as this would be considered a new stage 2 pressure injury. Inpatient hospitalizations for patients with a stage 1 pressure injury present on admission are not excluded from the measure's denominator. Regarding your second question: This question is out of scope for the eCQM Issue Tracker. Please submit any questions about the Hospital-Acquired Conditions (HAC) Reporting Program via QualityNet: https://cmsqualitysupport.servicenowservices.com/qnet_qa
    • CMS0826v3
    • CMS0826v2
    • Important to understand for proper POA Indicator Assignment.

      Based on a response for CMS826v2 (Ticket CQM-7791), I understand that a pressure injury that is coded present on admission (coded as POA-Y) does not get subsequently re-coded to POA-N if the pressure injury deteriorates to a higher stage during the hospitalization. And that the numerator requires a new deep tissue pressure injury (DTPI) or stage 2, 3, 4 or unstageable pressure injury.

      Question #1: Is this true also true for CMS826v3?

      Question #2: Is this also true for Hospital-Acquired Conditions (HAC) payment provision? In other words, if a Stage 2 Pressure Injury is POA-Y and it progresses to a Stage 4 Pressure Injury, is the Stage 4 coded as POA-Y?

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Mike Davis
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