Corporate Compliance

Present on admission reporting

Compliance Monitor, June 29, 2007

Q: Do you have any information on the present on admission (POA) indicator? Is it required? Do we have to report it on the UB-04 form or on the 837? If so, which loop and segment?

A: POA information will be mandatory for all states by January 2008. The POA information will appear as a modifier on some diagnosis codes (some diagnosis codes are exempt), and hospitals must submit this information to their payers in the current format (for most hospitals this will be on a UB-04 claim form).

Report whether a condition was POA using the following modifiers:

  • Y: Yes (present at the time of inpatient admission)
  • N: No (not present at the time of inpatient admission)
  • U: Unknown (documentation is insufficient to determine if condition is present at time of inpatient admission)
  • W: Clinically undetermined (provider is unable to clinically determine whether condition was present at time of inpatient admission or not)
  • 1: Unreported/Not used (exempt from POA reporting)

AHA Coding Clinic, Fourth Quarter, 2006 (pp. 241-255) provides an extensive explanation and reporting guidelines for POA. CMS has also published information on POA, including MLN Matters article MM5499 and Transmittal 1240, which states the following:

Effective for acute care inpatient PPS discharges on or after October 1, 2008, the Secretary cannot assign cases with these conditions to a higher paying DRG unless they were present on admission.

This instruction will require hospitals to begin reporting the POA code on claims with discharges beginning on or after October 1, 2007. Although hospitals must report the POA code on the claim, the information will not be used by claims processing systems until January 1, 2008. Beginning with claims with discharges on or after January 1, 2008, if hospitals do not report a valid POA code for each diagnosis on the claim, the claim will continue to process. However, hospitals will be provided with a remark code on their remittance advice advising them that they did not correctly submit the POA code on the claim.

Beginning April 1, 2008, if hospitals do not report a valid POA code for each diagnosis on the claim, the claim will be returned to the hospital for correct submission of POA information. Direct data entry (DDE) screens cannot be updated to include a space for entering POA information until January 1, 2008. Therefore, hospitals that submit claims via DDE will be unable to submit the POA indicator on October 1, 2007. These hospitals must begin submitting the POA indicator on January 1, 2008.
 
For more information on reporting POA, see the ICD-9-CM Official Guidelines for Coding and Reporting at HHS' Centers for Disease Control and Prevention Web site. Scroll down to p. 91 to find the POA guidelines.

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