Present on Admission Indicators

The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payments for certain hospital-acquired conditions. CMS has titled the provision "Hospital-Acquired Conditions and Present on Admission Indicator Reporting" (HAC & POA). Inpatient Prospective Payment System (IPPS) hospitals are required to submit POA information on diagnoses for inpatient discharges.

POA Reporting Requirements

  • Required on all IPPS claims with inpatient admissions
  • Present at the time of the inpatient admission order
    • Includes conditions that develop during an outpatient encounter
  • Assigned to principal and secondary diagnosis
  • Claim billed with all appropriate charges regardless of POA
    • Adjustment for HAC will be made based on POAs on claim

POA Reporting Options, Definitions and Payment

Indicator Description Medicare Payment
Y Diagnosis was present at time of inpatient admission.

CMS will pay the CC/MCC DRG for those selected HACs that are coded as "Y" for the POA Indicator.
Payment made for condition by Medicare, when an HAC is present
N Diagnosis was not present at 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
No payment made for condition by Medicare, when an HAC is present
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
No payment made for condition by Medicare, when an HAC is present
W Clinically undetermined. Provider 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.
Payment made for condition by Medicare, when an HAC is present
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. For a complete list of codes on the POA exempt list, see the Official Coding Guidelines for ICD-9-CM. https://www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm
Exempt from POA reporting

 

POA Exempt Diagnosis Codes

Certain diagnosis codes are exempt for POA reporting. It important to review this list to ensure inpatient claims are submitted correctly. Select appropriate POA Exempt List under the Downloads section of the CMS Hospital Acquired Conditions (Present on Admission Indicator) Coding webpage.

 

Last Updated Mon, 24 Feb 2020 10:53:48 +0000