Performance Interview Planning Checklist

POA Audit Review Sheet

Purpose: To assess the process of the assignment of present on admission indicators (POA)
for ICD-9 code 707.0X, pressure ulcers to determine the appropriateness of physician
documentation, POA indicator assignment, and the quality of care at Medaille Memorial
Hospital.
Medical Record Review
MEDICAL RECORD # _________

Yes

No

Not
Applicable Comments

Is the diagnosis of pressure ulcer

present in the admission order/form?
Is the diagnosis of pressure ulcer
resent in the emergency room
record?
Is the diagnosis of pressure ulcer
present in the history and physical
documentation?
Is the diagnosis of pressure ulcer
present in the physicians progress
notes?
Is the diagnosis of pressure ulcer
present in the nursing progress
notes?
Is the diagnosis of pressure ulcer
present in the operative or
postoperative report?
Is the diagnosis of pressure ulcer
present in any laboratory or radiology
reports?
Is the diagnosis of pressure ulcer
present in any consultative reports?
Is the diagnosis of pressure ulcer
present in the discharge summary?

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Performance Interview Planning Checklist

Physician Query Process

Yes

No

Yes

No

Not
Applicable Comments

If the documentation regarding

pressure ulcers in the medical record
was found to be unclear, inconsistent
or missing, was a physician query
initiated?
If a physician query was initiated, did
the physician respond within the
appropriate time period?
Was the physicians response to the
query appropriate?

Clinical Coding Process

Not
Applicable Comments

Did the coder code the diagnosis of

pressure ulcer as ICD-9 code,
707.23?
Did the coder code the diagnosis of
pressure ulcer as ICD-9 code,
707.24?
Based on the medical record review,
was the POA indicator correctly
assigned?

Recommendations:
____________________________________________________________________________
____________________________________________________________________________
Auditor: _____________________________

Date: _____________________________

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