Ten Years On: A Look at POA Indicators a Decade after Implementation

Posted by admin | October 5, 2017 , (0) comments

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In order to ensure proper reimbursement, it is essential for inpatient health care facilities to record the medical conditions that the patient has when they are admitted. This information is documented using Present On Admission (POA) indicators. POA indicators differentiate between medical conditions that were present at the time of inpatient admission and those that developed at some point between admission and discharge.

The use of POA indicators was introduced in 2005 as part of the Deficit Reduction Act, which mandated that POA indicators be reported on all Medicare inpatient acute care claims for patients discharged on or after October 1, 2007. This week marks a decade since the legislation took effect, but reporting with POA indicators can still present challenges for health care providers today. Read on to learn about some of the complex issues associated with POA indicators.

The Five POA Indicators

POA indicators are assigned to principal diagnosis codes, secondary diagnosis codes, and external cause of injury codes. There are five POA indicators that doctors must choose from:

A) Y: Yes, which is used for conditions that are present at the time of inpatient admission

B) N: No, which is used for conditions that are not present at the time of inpatient admission

C) U: Unknown, which is used when it is not known whether a condition was present at the time of inpatient admission

D) W: Clinically Undetermined, which is used when the provider was not able to clinically determine whether the condition was present at the time of inpatient admission

E) 1 / Blank, which is used for conditions that are exempt from POA reporting.

It can often be difficult to determine which of the codes to report. Sometimes, the line between the U and the W code is blurred. It is also easy to make a mistake and accidentally report a Y for a condition that is actually exempt from POA reporting.

POA Exempt Diagnosis Codes

A POA exempt diagnosis code should be reported as 1 (on electronic claims) or left blank (on paper claims). However, it can be challenging to keep track of which codes are exempt from POA reporting. Each year, the Centers for Medicare and Medicaid Services updates its list of POA exempt codes, and the changes can be extensive. In 2017 alone, there were 1,814 ICD-10-CM codes added, 178 codes deleted, and 348 codes revised. In total, the number of POA exempt codes for 2017 was 36,875.

If your practice has had trouble with POA indicators over the last decade, you should consider outsourcing your medical coding AnnexMed. The guidelines for reporting POA indicators will continue to be complex, so instead of risking the disruption of your revenue cycle, it makes sense to let the experts handle it. Contact us today for more information about your services!

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