Priority Health follows CMS standards in requiring hospitals to report present-on-admission (POA) indicators for principal and secondary diagnoses, including external causes of injuries, present at the time of all inpatient admissions for members of all plans. Also see CMS guidelines on diagnoses not requiring POA indicators.

POA conditions also include those that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery. Your reimbursement may be reduced for services that include a diagnosis that was not present on admission.

Claims without a POA indicator will be rejected, unless the diagnosis code is exempt from POA reporting.

POA indicators

• Y - Diagnosis was present at the time of inpatient admission
• N - Diagnosis was not present at the time of inpatient admission
• U - Documentation is insufficient to determine if condition was present at the time of admission
• W - Unable to determine clinically if the condition was present at the time of admission
• Blank - Only use if the diagnosis is exempt from POA reporting

Go to the CMS website information on coding for POAs, including lists of codes exempt from POA reporting.

Paper claims

On the UB-04, the POA indicator is the eighth digit of Field Locator (FL) 67, Principal Diagnosis, and the eighth digit of each of the Secondary Diagnosis fields.

Electronic claims

Using the 837I, submit the POA indicator in segment K3 in the 2300 loop, data element K301.