Provider Notice issued 03/12/08

Present on Admission (POA) Indicator

Effective with admissions on and after May 1, 2008, Healthcare and Family Services (HFS) will require hospitals to submit a Present On Admission (POA) Indicator for the principal diagnosis code and every secondary diagnosis code on inpatient hospital claims.  The requirement mirrors new Medicare requirements that were effective October 1, 2007.

The admitting diagnosis code, reported in FL69 on the UB-04 or Loop 2300, HI02, Qualifier BJ of the 837I and E Code(s), reported in FL72a-c on the UB-04 or Loop 2300, HI03, Qualifier BN of the 837I will not require a POA indicator. 

Present on Admission is defined as a condition that is present at the time the order for inpatient admission occurs.  Conditions that develop during an outpatient encounter, including emergency department services, observation, or outpatient surgery, are considered as present on admission.

This requirement will apply to all inpatient services and all hospitals.  Hospice providers are excluded from this requirement. 

At present, state implementation of this requirement is for data collection purposes only.  If the POA is not reported, the claim will not be rejected, but the hospital will receive the informational message I18 – POA Indicator Required on the paper Remittance Advice.  However, the department strongly encourages the reporting of this information. 

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 (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 (This code is the equivalent of a blank on the UB-04, but blanks are not allowed in the 837I transaction).  A list of these exempt diagnosis codes is identified in the 2008 ICD-9 Coding Guidelines, Appendix 1.

837I Reporting of the POA Indicator

The POA data element on an electronic claim (837I) must contain the letters “POA” followed by a single POA indicator as enumerated in the previous paragraph for the principal diagnosis code and every secondary diagnosis code(s) reported.  The POA indicator for the principal diagnosis should be the first indicator after “POA” and the POA indicators for the secondary diagnoses would follow.  The last POA indicator must be followed by the letter “Z” to indicate the end of the data element.  The POA indicator is reported in Loop 2300, K3 segment, data element K301.

UB-04 Reporting of the POA Indicator

The “POA” indicator is reported in the eighth digit (shaded area) of FL67 for the principal diagnosis and in the eighth digit (shaded area) of FL67A-Q for each secondary diagnosis.  If the POA indicator is not placed in the shaded areas noted, it will be captured as part of the diagnosis code, which may cause the claim to be rejected.

Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs