POA Indicator Refresher
The Present on Admission (POA) indicator identifies whether a diagnosis was present at the time of inpatient admission. POA reporting is required for all claims submitted to Medicare for inpatient discharges and directly affects Hospital-Acquired Condition (HAC) payment provisions.
The Four POA Indicator Values
- Y: present at the time of admission
- N: not present at the time of admission
- U: documentation insufficient to determine if the condition was present on admission
- W: clinically undetermined; the provider is unable to determine if the condition was present on admission
Exempt Conditions
Certain diagnosis codes are exempt from POA reporting because they represent conditions that always or almost always develop after admission, or that are chronic conditions unlikely to be present in a way that meaningfully affects HAC determination. CMS publishes an annually updated list of exempt codes.
Complex Scenarios
- Combination codes: when a single code represents both a condition and a complication, the POA indicator reflects whether both elements were present on admission; if any part developed after admission, the code is typically reported as "N"
- Conditions diagnosed after admission but clinically present earlier: if clinical evidence indicates the condition existed before admission even though it was not diagnosed until later, "Y" may be appropriate based on physician documentation
- Obstetric and perinatal conditions: often have unique POA considerations because certain conditions are inherently related to the birth process
Impact on HAC Reduction Program
A condition coded with a POA indicator of "N" that also appears on the CMS HAC list will not be treated as a comorbidity for DRG assignment purposes if it was acquired during the hospital stay, potentially resulting in a lower-weighted DRG and payment reduction under the HAC provisions.
Documentation Requirements
POA assignment must be based on provider documentation; coders cannot infer POA status without a clear, evidence-based clinical indicator or a query resolution. Ambiguous documentation should generate a compliant query rather than a coder assumption.
Exam Tip
Practice assigning POA indicators to combination codes and understand how an "N" designation for a HAC-listed condition changes DRG assignment and payment.