Section 5001(c) of the Deficit Reduction Act of 2005 requires hospitals to begin reporting the secondary diagnoses present on the admission of patients, effective for discharges on or after October 1, 2008. In order to implement Section 5001(c) of the Deficit Reduction Act of 2005, and to group diagnoses into the proper DRG, EmblemHealth must capture a Present on Admission (POA) indicator for all claims as shown below.
POA Code is needed for:
- General acute-care-hospital inpatient admissions for Medicare members discharged on or after October 1, 2008. The POA indicator is required for all inpatient admissions of Medicaid members discharged on or after July 1, 2009 (including those that are exempt per Medicare).
- A POA indicator is required for all diagnosis codes. If the diagnosis is exempt, enter a value of "1."
For billing purposes, a POA Code is not needed for Medicare member claims in the following hospitals:
- Critical Access Hospitals
- Inpatient rehabilitation facilities
- Inpatient psychiatric facilities
- Maryland Waiver Hospitals
- Long-Term Care Hospitals
- Cancer Hospitals
- Children's Hospitals
- Hospitals paid under any type of Prospective Payment System (PPS) other than the acute care hospital PPS
A POA Code is mandatory for Medicaid member claims for each diagnosis submitted in all inpatient facilities including Critical Access Hospitals and hospitalizations for:
- Substance abuse treatment
- Mental health admissions
- All medical inpatient services
General Reporting Requirements for Medicare and Medicaid members:
- All claims involving inpatient admissions to general acute care hospitals or other facilities that are subject to a law or regulation mandating collection of POA information.
- A POA indicator is assigned to principal and secondary diagnoses (as defined in Section II of the Official Guidelines for Coding and Reporting) and the external cause of injury codes.
- Issues related to inconsistent, missing, conflicting or unclear documentation must still be resolved by the provider.
- If a condition would not be coded and reported based on Uniform Hospital Discharge Data Set definitions and current official coding guidelines, then the POA indicator would not be reported.
- CMS does not require a POA indicator for the external cause of injury code unless it is being reported as an “other” diagnosis.
Reporting Options and Definitions:
- 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 4010A.