Present On Admission Indicator for Inpatient Claims

Effective for claims with a discharge date on or after January 1, 2008, a Present On Admission (POA) Indicator is required for every diagnosis on inpatient acute care hospital claims.

For inpatient claims submitted electronically via the ANSI X12 837 format, the POA will be submitted in the K3 segment of the 2300 Claim Information loop, data element K301 segment with the following reporting options:

• Y = Yes – Present at the time of inpatient admission

• N = No – Not present at the time of inpatient admission

• U = Unknown – The documentation is insufficient 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 or not.

• 1 = Unreported/Not Used – Exempt from POA reporting – This code is the equivalent code of a blank on the UB-04.

The K301 data element should contain the letters POA followed by a single POA indicator for every diagnosis code reported on the claim. The POA indicator for the principal diagnosis should be the first indicator after POA. POA indicators for secondary diagnoses would follow next. The last POA indicator for principal and, if applicable, other diagnoses shall be followed by the letter Z to indicate the end of the POA indicators or the letter X in special situations that may be identified in the future.

As an example, segment K3 might read as follows: POAYNUWIYZ.

It would represent the POA indicators for a claim with one principal and five secondary diagnoses. The number of POA indicators sent must be equal to the number of principal and, if applicable, eight other diagnoses on the claim. There will be an edit in place to insure that the numbers of POA indicators are equal to the number of diagnoses and that all POA indicators are valid. Claims that fail this edit will be reported on the Medicare Part A Reject report.

Source : CMS Change Request 5499