The Centers for Medicare & Medicaid Services (CMS) has updated the Reporting section of the Hospital-Acquired Conditions (HAC) & Present on Admission (POA) Indicator Reporting web site to describe the reason codes that are being shared with providers who are improperly submitting Present on Admission Indicator data. A list of the reason codes is available below.
On October 1, 2007, all Inpatient Prospective Payment System (IPPS) Hospitals were required to begin submitting Present on Admission (POA) Indicator information for all principal and secondary diagnoses. Instructions on how to report the appropriate POA indicator are included in the Official Guidelines for coding and Reporting found under the Related Links section below.
As of April 1, 2008, claims that are submitted for payment that do not contain proper reporting of the POA Indicator are being RETURNED.
The following reason codes indicate an error in POA reporting:
General Reporting Requirements
- POA indicator reporting is mandatory for all claims involving inpatient admissions to general acute care hospitals or other facilities.
- POA is defined as present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered POA.
- A POA Indicator must be 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. CMS does not require a POA Indicator for an external cause of injury code unless it is being reported as an "other diagnosis."
- Issues related to inconsistent, missing, conflicting, or unclear documentation must 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.
Change Request (CR) 6086 (PDF) instructs on correct POA Indicator reporting options and instructs the Grouper to not apply HAC logic to claims from exempt Inpatient hospitals. CR 6086 is available on the Statute/Regulations/Program Instructions page.