What Is Present on Admission
Present on admission, or POA, reporting identifies whether a diagnosis was present at the time the order for inpatient admission occurred. CMS requires POA indicator reporting on inpatient claims for all diagnoses to support hospital-acquired condition payment policies and quality monitoring.
POA Indicator Values
The four primary POA indicator values are Y, indicating the condition was present on admission; N, indicating the condition was not present on admission; U, indicating the documentation is insufficient to determine whether the condition was present on admission; and W, indicating the provider is unable to clinically determine whether the condition was present on admission. Each indicator carries different implications for HAC payment determinations.
Exempt Codes
Certain ICD-10-CM codes are exempt from POA reporting because the underlying condition could not reasonably develop or resolve during a single hospital stay, or because the code represents a condition that is always present on admission by definition. CMS publishes an annually updated list of exempt codes that coders must reference.
Official Guidelines
The ICD-10-CM Official Guidelines for Coding and Reporting include a dedicated section on POA reporting, addressing scenarios such as combination codes, conditions diagnosed prior to admission but confirmed after admission, and conditions with a documented unclear timing. Coders must apply these guidelines consistently to ensure accurate and defensible POA assignment.
Clinical Documentation Impact
Accurate POA determination depends on clear physician documentation specifying when a condition was identified relative to the admission order. Ambiguous documentation often results in a U indicator, which can trigger a physician query to clarify the timing of the condition's onset whenever possible.
Payment and Quality Implications
POA indicators directly affect whether a condition is treated as hospital-acquired for HAC payment provisions, and POA data also feeds into publicly reported quality measures related to patient safety. Given these downstream effects, coding and CDI teams should collaborate closely to ensure documentation supports accurate, timely POA determination for every reportable diagnosis.