What’s new with POA (Present on Admission) Reporting?

CMS issued Change Request (CR) 7680 to update the list of 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.

First, let’s review 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 it is 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 codes shall be blank
• Direct data entry (DDE) or hard copy claims cannot have an indicator of “1”
• K3 segment will not be reported on the 5010

Reporting requirements 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 which became effective October 1, 2011, were left off the exempt list.

ICD-9-CM CODES

CMS’ work around is to add a POA indicator of “W”. 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.

For a listing of the exempt codes, refer to CMS One-Time Notification, Transmittal 756.

Coders have struggled with the reporting of congenital conditions and conditions that originate in the perinatal period. Congenital conditions and anomalies, categories 740-759.9, are on the exempt list and require a blank or 1 depending on the claim form.

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.

According to the 2011 Official Coding and Reporting Guidelines, Certain Conditions Originating in the Perinatal Period are considered to be POA at the time of 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).

As always, I hope that this information has been helpful.

Happy Coding!

Mary

References
CMS Pub. 100-20 Transmittal: 756 Date 8-13-2010 Change Request 7024 Official Coding and Reporting Guidelines 2011

***This month's newsletter is contributed Mary Gregory, RHIT, CCS, CPC, CCS-P, CPC-I, AHIMA Certified ICD-10-CM/PCS Trainer ***

Post on Facebook
Post on Twitter
Reply to the MAS Blog
Email at askmary@mascodingsolutions.com

Online Medical Terminology Course

The foundation to understanding medical coding.

Learn More >

Online CPC/CPC-H Coding Course

Are you interested in becoming a
Certified Professional Coder (CPC)?

Learn More >

Are You Prepared for the
ICD 9 to ICD 10 Transition?

Let Us Help Develop Your
Training Program!

Click here to see how simple we
make the ICD 9 to ICD 10 conversion!

Current Medical Coders:

Do you have a question?

Ask Mary!

Quick Links: