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Required Facilities to Use POA Indicators

Point of Admission (POA) indicators are codes that indicate which diagnoses were present upon hospital admission, including the primary diagnosis as well as any secondary diagnoses. For example, did the patient present to the hospital with an infection, or did the infection occur during her admission? POA indicators were used nationwide starting in 2007. In 2010, a new UB-04 billing claim form contains a POA indicator field on claim forms sent to health plan payers.

  1. Background

    • In 1992, the National Committee on Vital and Health Statistics and the Uniform Hospital Discharge Data Set recommended POA indicators. Two years later, New York became the first state to implement POA indicators in public health reporting; California followed suit another two years after that. By 2005, 24 states had passed legislation regarding POA indicators. In the same year, the Medicare Payment Advisory Commission recommended to Congress that health care facilities be required to indicate on Medicare claim forms all secondary diagnoses that were present at the time of admission, noting that this data would significantly help identify avoidable complications.

    Effects

    • With the advent of POA indicators, conditions that arise during a hospital admission, some of which could have been prevented, will be more easily tracked with evidence-based guidelines. In terms of reimbursement, proper payment will be determined with a combination of diagnosis code and POA indicator. For hospital-acquired conditions, payment may be adjusted. Studies demonstrate that POA indicators have contributed to improvement in quality assurance and safety for patients. Use of the indicators reduces the number of false positive test results, improves patient safety and care and improves mortality risk.

    Required Facilities

    • All acute care medical centers that are subject to regulatory POA data collection are required to use POA indicators. Conditions that require a positive POA indicator are those that are regarded as being "present at the time the order for inpatient admission occurs."

    Official Guidelines

    • POA indicator guidelines state that POA codes are to be a collaboration between the healthcare provider and coder. The goal is to produce documentation that reflects correct coding and diagnosis. The physician or other qualified health care provider is legally responsible for ensuring correct diagnoses. Any documentation that is inconsistent or conflicting must be resolved by the provider. Finally, a POA indicator is not reported if, based on UHDDS definitions, a condition is not coded and reported.

    Reporting Options

    • Four POA reporting options exist: Y, meaning the condition was present at the time of hospital admission; N, meaning the condition was not present at the time of hospital admission; U, meaning not enough information is known to determine if the condition was present on hospital admission; and W, meaning the provider cannot clinically determine that the condition was present on hospital admission. The code U should be used only on very rare occasions.

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