Present on Admission (POA) Indicators in Inpatient Coding
The present-on-admission (POA) indicator is a new data element that CMS requires hospitals to report as of October 1, 2007, as part of the Defi cit Reduction Act of 2005.
POA refers to conditions that are present at the time an order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department (ED), observation, and outpatient surgery, are considered POA.
Coders should report a POA indicator for a principal diagnosis, as well as any secondary diagnoses or E codes. POA ties in with MS-DRGs because even though a condition may be classifi ed as a CC or MCC, that doesn’t mean that it will affect the MS-DRG assignment.
This is because as of October 1, 2008, hospitals will not receive additional payments for cases in which one of eight conditions develops but was not POA.
CMS will reimburse these cases as though the secondary diagnoses were not clinically present. The eight hospital-acquired conditions CMS targets in the 2008 IPPS fi nal rule (see the August 22 Federal Register) include:
· Serious preventable event (object left in surgery)
· Serious preventable event (air embolism)
· Serious preventable event (blood incompatibility)
· Catheter-associated urinary tract infection (CAUTI)
· Pressure ulcers (decubitus ulcers)
· Vascular catheter (associated infection)
· Surgical site infection (e.g., mediastinitis after coronary artery bypass graft)
· Hospital-acquired injuries, fractures, dislocations, intracranial injuries, crushing injuries, burns, and other unspecifi ed effects of external causes
Consider the following example:
A patient was admitted with acute atrial fi brillation and developed a decubitus ulcer during the hospitalization, which is identifi ed by a POA of “N.”
The DRG assignment would be MS-DRG 309; however, because the decubitus ulcer was not POA, CMS will calculate this case as though it were not present. This would result in MS-DRG 310.
The UB-04 includes an indicator fi eld specifi cally designed for POA assignment. Coders have to determine whether a condition was POA when the patient was admitted to the hospital or whether it developed during the hospital stay. Once coders fi nd this information, they can report one of the following indicators in the proper field:
POA Indicators:
Y/Yes: Present at the time of inpatient admission
N/No: Not present at the time of inpatient admission
U/Unknown: The documentation is insuffi cient 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
1 - Unreported/Not Used (for electronic claims filing)
1 - Unreported/Not Used (for electronic claims filing)
