Present on Admission Indicators – Changes Effective July 1, 2011
Coding requirements for hospitals have been in effect since October 1, 2008, to facilitate the identification of hospital acquired conditions (HAC) not present on admission. For every diagnosis code reported, one of the following present on admission (POA) indicators must also be reported:
- Y – Present on admission
- W – Based on data and clinical judgment it is not possible to document when the onset of the condition occurred
- N – Not present on admission
- U – Documentation is insufficient to determine if the condition was present at the time of admission
- 1 – Exemption from POA reporting
Regardless of your contract payment arrangements, Blue Cross and Blue Shield of Texas (BCBSTX) does require that a POA indicator be filed on all inpatient hospital claims.
At this time, the following hospitals are EXEMPT from filing the POA Indicator:
- Long-term acute care hospitals (LTCHs or LTACs)
- Inpatient rehab facilities (IRFs)
- Inpatient psych facilities (IPFs)
- Cancer hospitals
- Children's hospitals
However, these exempt hospital types are still subject to non payment as stated in the HAC and never event policies in the BCBSTX facility provider manual on our website.
Effective July 1, 2011, if your hospital does not file a POA indicator, it will be defaulted to an “N” and could affect your reimbursement.
If you have any questions, please contact your facility network provider representative.