Hospital-Acquired Conditions

(Present on Admission Indicator)

"On February 8, 2006, the President signed the Deficit Reduction Act (DRA) of 2005. Section 5001(c) of DRA 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. Section 5001(c) provides that CMS can revise the list of conditions from time to time, as long as it contains at least two conditions. The statute is available in the Statute/Regulations/Program Instructions section, accessible through the navigation menu at left.

For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission. That is, the case would be paid as though the secondary diagnosis were not present. An example of how the HAC provision may affect an MS-DRG payment, beginning October 1, 2008, is presented below.

CMS also required hospitals to report present on admission information for both primary and secondary diagnoses when submitting claims for discharges on or after October 1, 2007"

The 14 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. Blood incompatibility
  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
    • Other injuries
  6. Catheter-Associated Urinary Tract Infection (UTI)
  7. Vascular Catheter-Associated Infection
  8. Surgical site infection (SSI) following Coronary Artery Bypass Graft (mediastinitis)
  9. Manifestations of Poor Glycemic Control
    • Diabetic Ketoacidosis
    • Nonketotic Hyperosmolar Coma
    • Hypoglycemic Coma
    • Secondary Diabetes with Ketoacidosis or Hyperosmolarit
  10. Deep vein thrombosis (DVT)/pulmonary embolism(PE) associated
    • total knee replacement
    • hip replacement
  11. Surgical site infection (SSI) following bariatric surgery i.e.
    • laparoscopic gastric bypass
    • gastroenterostomy
    • laparoscopic gastric restrictive surgery
  12. Surgical site infection (SSI) following certain orthopedic procedures (spine, neck, shoulder, or elbow)
  13. Surgical site infection (SSI) following Cardiac Implantable Electronic Device (CIED
  14. Iatrogenic Pneumothorax with Venous Catheterization