Reason Code 34931

Reason Code Narrative

INPATIENT ACUTE CARE HOSPITALS CLAIM WITH A DISCHARGE DATE ON OR AFTER 4-1-08 MUST HAVE THE NUMBER OF PRESENT ON ADMISSION (POA) INDICATORS TO EQUAL THE NUMBER OF DIGNOSIS CODES ON THE CLAIM.

 YOUR CLAIM HAS BEEN SUBMITTED WITH A MISSING OR INVALID POA INDICATOR(S). PLEASE REVIEW YOUR DIAGNOSIS CODES ON YOUR CLAIM TO ENSURE THE POA INDICATOR IS CORRECTLY CODED. FOR EXEMPT DX CODES YOU MAY REFER TO CR7680 IT HAS GREAT DETAIL REGARDING EXEMPT CODES. CR 7680 ALSO ADDED A FEW NEW EXEMPT CODES THAT WILL NOT ACCEPT THE BLANK UNTIL 7-2012. BUT UNTIL THAT TIME YOU MAY CODE A W FOR THESE FEW CODES IN BR 7680.1 OTHERWISE: VALID VALUES FOR THE POA INDICATOR ARE:

  • Y = YES = PRESENT AT THE TIME OF INPATIENT ADMISSION
  • N = NO = NOT PRESENT AT THE TIME OF INPATIENT ADMISSION.
  • U = UNKNOWN = THE DOCUMENTATION IS INSUFFICIENT TO DETERMINE IF THE CONDITION WAS PRESENT AT THE TIME OF INPATIENT ADMISSION.
  • W = CLINICALLY UNDETERMINED = THE PROVIDER IS UNABLE TO CLINICALLY DETERMINE WHETHER THE CONDITION WAS PRESENT AT THE TIME OF INPATIENT ADMISSION OR NOT.
  • 1 = UNREPORTED/NOT USED - EXEMPT FROM POA REPORTING – THIS CODE IS THE EQUIVALENT CODE OF A BLANK ON THE UB-04, HOWEVER, IT WAS DETERMINED THAT BLANKS WERE UNDESIRABLE WHEN SUBMITTING THIS DATA VIA THE 4010A1.
  • BLANK FOR 5010 VERSION FOR UNREPORTED/NOT USED (EXEMPT FROM POA REPORTING)

Common Reason Code Errors

  • A claim has been submitted with a missing or invalid Present on Admission (POA) indicator. Number of POA indicators must equal to number of diagnosis codes on claim, unless diagnosis code is exempt from POA indicators

Common Reason Code Corrections

  • Review diagnosis codes on claim(s) to ensure POA indicator is correctly coded. For exempt diagnosis codes, refer to CR7680 for additional guidance regarding exempt diagnosis codes. It also details new exempt codes that will not accept a blank POA indicator. Refer to business requirement section (7680.1) in CR7680 for additional coding instructions. See "Reason Code Narrative" section above for listing of valid values for POA indicator

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Last Updated Aug 20, 2018