Friday, December 18, 2015

UB 04 - Form Locator - FL 67, 69 - POA indicator missing Denial

What steps can we take to avoid return to provider (RTP) reason code 34931?

A: One or more present on admission (POA) indicator(s) is/are missing, invalid or incorrectly submitted with the reported diagnosis code(s). It is recommended that you review each diagnosis code and POA indicator to ensure they are correct, prior to submitting your claim.

• POA is defined as being present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department and/or observation services, or outpatient surgery, are considered POA.

• Claims for inpatient admission to acute care inpatient prospective payment system (IPPS) hospitals must include the appropriate POA indicator for the principal and all secondary diagnoses, unless the code is exempt.

• It is important to review the POA exempt list to ensure you are submitting your claims correctly. Refer to downloads on the CMS website, at Hospital Acquired Conditions (Present on Admission) - Coding external link.

Note: The 2015 ICD-9-CM and ICD-10-CM POA exempt lists are identical to the 2014 ICD-9-CM and ICD-10-CM POA exempt lists. There were no changes.

• The CMS Hospital-acquired conditions (HAC) and present on admission (POA) indicator reporting provision external pdf file fact sheet provides background information, additional resources and general reporting requirements.
The following hospitals are exempt from this provision:
• Critical access hospitals
• Long term care hospitals
• Cancer hospitals
• Children’s inpatient facilities
• Religious non-medical health care institutions
• Inpatient psychiatric hospitals
• Inpatient rehabilitation facilities
• Veteran’s administration/department of defense hospitals

Valid values for POA indicators are:

Code Reason for code

Y Diagnosis was present at time of inpatient admission.
N Diagnosis was not present at time inpatient admission.
U Documentation insufficient to determine if the condition was present at the time of inpatient admission.
W Clinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission.

‘Blank’ Unreported/not used. Exempt for POA reporting.

Note: Blank is used on UB-04 claim form and the equivalent 5010 electronic claim version.

Hospital in patient claims form locator FL 67, 69

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