I have a pt that came in for a Swingbed admit for late effects of a CVA/SAH, she was then transferred to acture for a MRSA pneumonia and then was transferred back to SWB, where 1/2 way through the this admit, she became symptomatic for abd pain, leukocystitis, hypocholermia, etc. The last half of her stay we were concentrating on caring for her new acute symptoms in order to transfer her back to Mass General where she was initially treated for the CVA/SAH back in November where she had a shunt put in her abdomen and may be the cause of the abd pain she is having now. On the progress notes and d/s the only things listed by the physician are the acute symptoms. My question is about the PDX. Do I follow i/p coding guidelines and code the late effects, which are POA exempt, but are the reason for initial admit, or do I use the the symptoms she is having now which is the primary care she is being given is for, which are all "N" for POA, or do I just use her chronic condition which has nothing at all to do with her care now except for medication issues but it is a "Y" for POA? We are a critical access hospital so our payment rules are a little different. I am leaning towards the initial reason for admit which are expemt from POA. Any help or input would be greatly appreciated.