Understanding Present On Admission (POA) Indicators: Implications for Medicare Billing

 Present On Admission (POA) Indicators

Provider Types Affected

 ** Hospitals submitting claims under the inpatient-prospective payment system (e.g., institutional claims to fiscal intermediaries [FI], institutional claims, or Medicare Part A/B Administrative Contractors [A/B MACs] as appropriate) for services furnished to Medicare beneficiaries.

3) Tufts Health Plan suggests that your billing staff is informed of this requirement, and your physicians – and other practitioners and coders – are working together to document, code and report diagnoses and procedures completely and accurately.

Reporting Options and Definitions

N (No) Not present at the time of inpatient admission

 U (Unknown) The documentation is insufficient to determine if the condition is present at the time of inpatient admission.

W Not Applicable

Y (Yes) Present at the time of inpatient admission

 POA, as the data element relating to the payer of the electronic claim on the K3 segment (version 4010A1) has been moved to the HI – PRINCIPAL  DIAGNOSIS and HI – OTHER DIAGNOSIS INFORMATION segments.

NOTE: The value of “1” has been removed in 5010.

Example: Below is an example of acceptable coding on an electronic claim: HI*BF:4821:::::::N*HI*BF:25000:::::::Y