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.