Hospital-Acquired Conditions

Present on Admission Indicator

Section 5001(c) of The Deficit Reduction Act (DRA) of 2005 requires the Secretary to identify conditions that are: 

1. High cost or high volume or both, 
2. Result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and 
3. 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 on the Statute/Regulations/Program Instructions page.

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

HAC Payment Provision

Payment implications began October 1, 2008, for the Hospital-Acquired Conditions (HACs). 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.

The 14 categories of HACs are listed below:

• Foreign Object Retained After Surgery
• Air Embolism
• Blood Incompatibility
• Stage III and IV Pressure Ulcers
• Falls and Trauma
  • Fractures
  • Dislocations
  • Intracranial Injuries
  • Crushing Injuries
  • Burn
  • Other Injuries
• Manifestations of Poor Glycemic Control
  • Diabetic Ketoacidosis
  • Nonketotic Hyperosmolar Coma
  • Hypoglycemic Coma
  • Secondary Diabetes with Ketoacidosis
  • Secondary Diabetes with Hyperosmolarity
• Catheter-Associated Urinary Tract Infection (UTI)
• Vascular Catheter-Associated Infection
• Surgical Site Infection, Mediastinitis, Following Coronary Artery Bypass Graft (CABG):
• Surgical Site Infection Following Bariatric Surgery for Obesity
  • Laparoscopic Gastric Bypass
  • Gastroenterostomy
  • Laparoscopic Gastric Restrictive Surgery
• Surgical Site Infection Following Certain Orthopedic Procedures
  • Spine
  • Neck
  • Shoulder
  • Elbow
• Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED)
• Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) Following Certain Orthopedic Procedures:
  • Total Knee Replacement
  • Hip Replacement
• Iatrogenic Pneumothorax with Venous Catheterization

The ICD-10 HAC Lists for FY 2016 through the current FY are available in the ICD-10 HAC List page.