POA Exempt Codes

$447.50 / year

This dataset shows the list of ICD-10-CM code that is exempt from the Present on Admission (POA) reporting from 2016 to 2019 by the Centers for Medicare and Medicaid Services (CMS). Present On Admission is defined as present at the time the order for inpatient admission occurs — conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered POA.

Complexity

Present on Admission (POA) indicators must be reported on each diagnosis code submitted on facility claims, except for “specific” diagnosis codes. CMS publishes a listing of diagnosis codes that are exempt from the POA indicator requirement.

To group diagnoses into the proper Diagnosis Related Group (DRG), Centers for Medicare and Medicaid Services (CMS) needs to capture a Present on Admission (POA) Indicator for all claims involving inpatient admissions to general acute care hospitals. The POA Indicator guidelines are not intended to provide guidance on when a condition should be coded, rather provide guidance on how to apply the POA Indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I, II, and III of the official coding guidelines. Subsequent to the assignment of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, the POA Indicator should be assigned to all diagnoses that have been coded.

As stated in the Introduction to the ICD-9-CM Official Guidelines for Coding and Reporting, a joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Medical record documentation from any qualified healthcare practitioner who is legally accountable for establishing the patient’s diagnosis.

The provider, a provider’s billing office, third-party billing agents and anyone else involved in the transmission of this data shall ensure that any resequencing of diagnosis codes prior to transmission to CMS also includes resequencing of the POA Indicators.

The Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule determined payment implications for each of the different POA Indicator reporting options. To review the payment implications, see the CMS POA Indicator Options and Definitions below:

– Y : Diagnosis was present at the time of inpatient admission. CMS will pay the Complication or Comorbidity (CC) or a Major Complication or Comorbidity (MCC)) drug for those selected Hospital-Acquired Conditions (HACs) that are coded as “Y” for the POA Indicator.
– N : Diagnosis was not present at the time of inpatient admission. CMS will not pay the CC/MCC DRG for those selected HACs that are coded as “N” for the POA Indicator.
– U : Documentation insufficient to determine if the condition was present at the time of inpatient admission. CMS will not pay the CC/MCC DRG for those selected HACs that are coded as “U” for the POA Indicator.
– W : Clinically undetermined. The Provider is unable to clinically determine whether the condition was present at the time of inpatient admission. CMS will pay the CC/MCC DRG for those selected HACs that are coded as “W” for the POA Indicator.
– 1 : Unreported/Not used. Exempt from POA reporting. This code is equivalent to a blank on the UB-04, however; it was determined that blanks are undesirable when submitting this data via the 4010A. CMS will not pay the CC/MCC DRG for those selected HACs that are coded as “1” for the POA Indicator. The “1” POA Indicator should not be applied to any codes on the HAC list.

Date Created

2015-08-18

Last Modified

2019-08-08

Version

2019-08-08

Update Frequency

Annual

Temporal Coverage

2016-2020

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

POA Indicator, Present on Admission, POA Exempt List, POA Indicator Options, POA Reporting, POA Indicator Requirement, POA Exempt Codes, Present On Admission Exempt ICD-10-CM Codes, POA Add Codes

Other Titles

POA Indicator Options Exempt Code 2016-2020, POA Indicator Options and Definitions

NameDescriptionTypeConstraints
YearYear of the POA exempt codesdate-
Ordering_CodeA number as text (with leading zeros), corresponding to the code ordering in the classification, and in the descriptions list file, for FY 2016-2020.integerlevel : Nominal
POA_Exempt_CodeThe ICD-10-CM code that is exempt from POA reporting.string-
DescriptionThe long title for the ICD-10-CM code, corresponding to the descriptions list file.string-
YearOrdering CodePOA Exempt CodeDescription
20161222B90.0Sequelae of central nervous system tuberculosis
20161223B90.1Sequelae of genitourinary tuberculosis
20161224B90.2Sequelae of tuberculosis of bones and joints
20161225B90.8Sequelae of tuberculosis of other organs
20161226B90.9Sequelae of respiratory and unspecified tuberculosis
20161227B91Sequelae of poliomyelitis
20161228B92Sequelae of leprosy
20161230B94.0Sequelae of trachoma
20161231B94.1Sequelae of viral encephalitis
20161232B94.2Sequelae of viral hepatitis