PRESENT ON ADMISSION (POA) What does Present on Admission (POA) stand for? POA is defined as a diagnosis present at the time the order for inpatient admission occurs. The POA indicator is to differentiate between conditions present at admission and conditions that develop during an inpatient admission. Conditions that develop during an outpatient encounter, including emergency department, observation or outpatient surgery, are considered POA. POA indicator reporting is mandatory for all claims involving inpatient admissions to general acute care hospitals or other facilities (excluding CAHs). The POA indicators will follow the diagnosis code in FL 66 (or loop 2300 HI segment). A POA indicator must be assigned to principal and secondary diagnoses, except those listed on the exclusion list. Failure to report a valid POA indicator will result in your claim being returned/rejected. Reason code 34931 continues to be a top 10 billing error. Reason Code 34931 Definition: Acute care claims must contain valid values in the present on admission (POA) indicators. The POA indicators on non-acute claims must be spaces. Resolution: Verify the POA indicator is correct for the diagnosis. Verify that the number "1" was not used in the POA field. Unless the diagnosis is exempt from POA reporting there is a POA indicator associated with every diagnosis and, codes that are exempt from the POA reporting requirement should be left 'blank'. DISCLAIMER - The information in these publications are provided "as is" without any expressed or implied warranty. While all information in these documents are believed to be correct at the time of writing, these documents are for educational purposes only and do not purport to provide legal or medical advice. It is the provider's responsibility to stay current with CMS and the Medicare Administrative Contractor's (MAC) guidelines. CPT codes, descriptors, and other data only are copyright 2013 American Medical Association. All rights reserved, Applicable FARS/DFARS apply. DM Quality Consulting, LLC 1
POA Indicators POA indicator 1 was discontinued in CY 2010. ICD-9-CM diagnosis codes that are exempt from the POA reporting requirement should be left blank instead of populating a 1. To find the list of ICD-9-CM codes on the POA exempt list, refer to the ICD-9-CM Official Guidelines for Coding and Reporting ( Official Guidelines ) located on the Centers for Disease Control and Prevention (CDC) website: DM Quality Consulting, LLC 2
http://www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm CMS also maintains the POA exempt list, both ICD-9 and ICD-10, on the Hospital Acquired Conditions Coding website: http://www.cms.gov/medicare/medicare-fee-for-service- Payment/HospitalAcqCond/Coding.html Steps to Correct RTP 34931 There are two steps you can take to correct RTP 34931. First, print-out the claim so that you can visually see how it was submitted to Medicare. Review each diagnosis code in FL 66 and the indicator. If the POA field is blank, view the list of exempt diagnoses to ensure it s on the list. If not, add an indicator. If there is a 1 indicator, remove and ensure the diagnosis is on the exempt list. Review the remaining diagnosis codes to ensure they are not on the exempt list; if so, remove the indicator. Remember, if the diagnosis is on the exempt list, leave the POA field blank. The next step is to correct the claim. If you do not have DDE access, resubmit a new claim. With DDE access, go into the Claim Correction Menu and select Inpatient. DM Quality Consulting, LLC 3
MAP 1741 will be the next screen you see. Since you are in the Claims Correction menu, status location will be T B9997, which are the RTP claims. From this screen, enter the NPI, the patient s HIC number and the date of service. Put an S under the SEL column, next to the claim that needs correcting. From claim page 1, hit the F8 key, twice. You want to make corrections on claim page 3. DM Quality Consulting, LLC 4
On claim page 3, make the corrections in the diagnosis code fields. Once corrections have been made, hit the F9 key to resubmit the claim. Recap POA indicators are required on IHS acute care hospital inpatient claims, not Critical Access Hospitals. Diagnosis codes exempt from POA reporting should be left blank; not with a 1 indicator. Missing or invalid POA indicators will cause the claim to RTP. Corrections can be made in DDE. CMS POA guidelines can be found on the Coding page of the CMS Hospital Acquired Conditions (Present on Admissions) webpage. Resources: CMS POA Fact Sheet: http://www.cms.gov/outreach-and-education/medicare-learning-network- MLN/MLNProducts/downloads/wPOAFactSheet.pdf DM Quality Consulting, LLC 5