CurrentAetnaPolicy N/A

Present on Admission (POA) indicator coding

This document governs the requirement to report Present on Admission (POA) indicator codes for inpatient diagnosis coding affecting Aetna members in New Jersey across Commercial and Medicare lines of business.

Policy Summary

PayerAetna

PolicyPresent on Admission (POA) indicator coding

Policy CodePolicy N/A

Change TypeNo material change

Effective DateOct 1, 2008

Next Review Date

Key ActionReport POA indicator codes for all primary and secondary inpatient diagnosis codes for Commercial and Medicare members; POA is not required for the admitting diagnosis.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

since 10/1/2008requirement effective date

Commercial & Medicarelines of business affected

primary & secondarydiagnosis codes requiring POA

admittingdiagnosis code not requiring POA

POA Reporting Requirements

POA reporting criteria

Reporting requirements for Present on Admission (POA) indicators.

ALL of the following

POA reporting applies to both Commercial and Medicare members.

ALL of the following

A POA code is required for all primary and secondary inpatient diagnosis codes.

ALL of the following

A POA code is not required for the admitting diagnosis.

ALL of the following

Policy Summary

PayerAetna

PolicyPresent on Admission (POA) indicator coding

Policy CodePolicy N/A

Change TypeNo material change

Effective DateOct 1, 2008

Next Review Date

Key ActionReport POA indicator codes for all primary and secondary inpatient diagnosis codes for Commercial and Medicare members; POA is not required for the admitting diagnosis.

SourceLink

On This Page

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This POA reporting requirement has been in effect since 10/1/2008.

POA Indicator Codes

POA indicator codesmixed

Y	Diagnosis was present at the time of inpatient admission.
N	Diagnosis was not present at the time of the inpatient admission.
U	Documentation insufficient to determine if condition was present at the time of inpatient admission.
W	Clinically undetermined. Provider unable to clinically determine whether the condition was present at the time of the inpatient admission.
1 or spaces	Unreported/not used. Exempt from POA reporting.

What Providers Must Do

Documentation Required

Report POA for all primary and secondary inpatient diagnoses

Report POA indicator codes for all primary and secondary inpatient diagnosis codes for Commercial and Medicare members; POA is not required for the admitting diagnosis.

Applies to both Commercial and Medicare lines of business.
Requirement effective since 10/1/2008.
POA not required for the admitting diagnosis code.

Key Definitions

Present on Admission (POA) — definition and purpose related to DRG assignment and coding

Definition'Present on Admission' (POA) indicator codes indicate whether a diagnosis was present at the time of inpatient admission and are used to help determine appropriate Diagnosis Related Group (DRG) assignments and pricing.

ApplicabilityRequired for Commercial and Medicare lines of business in New Jersey (effective since 10/1/2008).

ScopePOA codes must be reported for all primary and secondary inpatient diagnosis codes.

ExclusionPOA reporting is not required for the admitting diagnosis code.

PurposeSupports correct DRG assignment and reimbursement by identifying conditions present on admission versus those acquired during the inpatient stay.