CMS issued Change Request (CR) 7680 to update the list ICD-9-CM codes, exempt from present on admission (POA) reporting for discharges on or after October 1, 2011. CR 7680 is planned to be implemented on July 2, 2012.
Let’s first the Reporting Definitions:
Y = present at the time of inpatient admission
N = not present at the time of inpatient admission
U = documentation is insufficient to determine if condition is present on admission
W = provider is unable to clinically determine whether condition was present on admission or not
It is important that facilities know what claim form that they are using to report the POA accurately.
Reporting requirements for Claim Form 5010-837i:
- POA indicator of “1” is not allowed on 5010 claim form for exempt codes
- Exempt ICD-9-CM diagnosis code shall be blank
- DDE or hard copy claims cannot have an indicator of “1”
- K3 segment will not be reported on the 5010
Reporting requirement for Claim Form 4010A1—837i:
- POA indicator of “1” will continue to be reported for exempt ICD-9-CM codes (POA indicator ‘1’ is still valid on a 4010A1 claim)
- K3 segment will continue to be reported
Some of the new ICD-9-CM codes that became effective 10-1-2011 were left of the exempt list. CMS has created a work around. Let’s review.
The following diagnosis codes were added to the exempt list, effective October 1, 2011, and require the “W.”
Note: Only the codes listed above require the “W” POA indicator. If the “W” indicator is incorrectly added to other diagnosis codes, the claim will be RTP with reason code 34931.
If the code is not on either list (meaning it is not exempt); facilities should apply the appropriate POA indicator.
Coders have struggled with the reporting of congenital conditions and conditions that originates in the perinatal period. Please note that congenital codes 740-759.9 are on the POA exempt reporting list.
POA Reporting Guidelines:
Congenital conditions and anomalies (2011 Official Coding and Reporting Guidelines)
Assign “Y” for congenital conditions and anomalies, except for categories 740-759, Congenital anomalies, which are on the exempt list. Congenital conditions are always considered present on admission.
Conditions originating in the perinatal period 760-779.9 are not exempt and according to the POA reporting guidelines these conditions are considered to be present on admission at birth.
Perinatal Conditions (2011 Official Coding and Reporting Guidelines):
Newborns are not considered to be admitted until after birth. Therefore, any condition present at birth or that developed in utero is considered present at admission and should be assigned “Y”. This includes conditions that occur during delivery (e.g., injury during delivery, meconium aspiration, exposure to streptococcus B in the vaginal canal).
CMS Pub. 100-20 Transmittal: 756 Date 8-13-2010 Change Request 7024
Official Coding and Reporting Guidelines 2011
P.S. I would like to take this time to apologize for the typographical errors in our January newsletter. Please forgive us. We are endeavoring to always do better.