Hospital-Acquired Conditions

(Present on Admission Indicator)

Section 5001(c) of Deficit Reduction Act of 2005 requires the Secretary to identify conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines.

On July 31, 2008, in the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule, CMS included 10 categories of conditions that were selected for the HAC payment provision. The IPPS FY 2009 Final Rule is available in the Statute/Regulations/Program Instructions section, accessible through the navigation menu at left.

The 10 categories of HACs include:

  1. Foreign object (such as a sponge or needle) inadvertently left in patients after surgery
  2. Air embolism - an air bubble that enters the blood stream and can obstruct the flow of blood to the brain and vital organs
  3. Transfusion with the wrong type of blood
  4. Severe pressure ulcers – deterioration of the skin, due to the patient staying in one position too long, that has progressed to the point that tissue under the skin is affected (Stage III), or that has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints (Stage IV)
  5. Falls and Trauma that result in the following injuries
    • Fractures
    • Dislocations
    • Intracranial Injuries
    • Crushing Injuries
    • Burns
    • Electric Shock
  6. Manifestations of Poor Glycemic Control
    • Diabetic Ketoacidosis
    • Nonketotic Hyperosmolar Coma
    • Hypoglycemic Coma
    • Secondary Diabetes with Ketoacidosis
    • Secondary Diabetes with Hyperosmolarity
  7. Catheter-Associated Urinary Tract Infection (UTI)
  8. Vascular Catheter-Associated Infection
  9. Surgical Site Infection Following:
    • Coronary Artery Bypass Graft (CABG) - Mediastinitis
    • Bariatric Surgery
      • Laparoscopic Gastric Bypass
      • Gastroenterostomy
      • Laparoscopic Gastric Restrictive Surgery
    • Orthopedic Procedures
      • Spine
      • Neck
      • Shoulder
      • Elbow
  10. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) following:
    • Total Knee Replacement
    • Hip Replacement

Payment implications began October 1, 2008 for these 10 categories of HACs.

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