CIC Present on Admission (POA) Indicators and Reporting 1 — Questions and Answers
Question 1: What does the POA indicator 'Y' represent in inpatient coding?
- The condition developed after admission
- The condition was present at the time of inpatient admission (Correct answer)
- The documentation is insufficient to determine POA status
- The condition is exempt from POA reporting
Correct answer: The condition was present at the time of inpatient admission
POA indicator 'Y' means the condition was present at the time of the order for inpatient admission.
Question 2: Which federal legislation mandated hospitals to report Present on Admission (POA) indicators for Medicare inpatient claims?
- The Health Insurance Portability and Accountability Act (HIPAA) of 1996
- The Affordable Care Act of 2010
- The Deficit Reduction Act of 2005 (Correct answer)
- The Medicare Modernization Act of 2003
Correct answer: The Deficit Reduction Act of 2005
The Deficit Reduction Act of 2005 directed CMS to identify hospital-acquired conditions and required POA indicator reporting to distinguish them from conditions present at admission.
Question 3: What POA indicator is assigned when clinical documentation is insufficient to determine if a condition was present at the time of inpatient admission?
- Y
- N
- U (Correct answer)
- W
Correct answer: U
POA indicator 'U' is assigned when documentation is insufficient to determine whether the condition was present on admission.
Question 4: A patient develops a urinary tract infection on post-operative day 3, with no evidence of infection at admission. Which POA indicator applies?
- Y
- N (Correct answer)
- U
- W
Correct answer: N
POA indicator 'N' is assigned when a condition was NOT present at the time of inpatient admission, such as an infection that developed during the hospital stay.
Question 5: Hospital-Acquired Conditions (HACs) that are NOT present on admission may result in which financial consequence under Medicare?
- Increased MS-DRG reimbursement for the additional complexity
- No change in reimbursement regardless of POA status
- Loss of additional payment — CMS pays as if the secondary diagnosis were not present (Correct answer)
- Automatic denial of the entire inpatient claim
Correct answer: Loss of additional payment — CMS pays as if the secondary diagnosis were not present
When a designated HAC is not present on admission, CMS does not pay the higher MS-DRG rate associated with that complication or comorbidity, reducing hospital reimbursement.
Question 6: Which of the following code categories is EXEMPT from POA indicator reporting?
- ICD-10-CM codes for chronic conditions such as hypertension
- ICD-10-CM codes for acute myocardial infarction
- External cause codes (V, W, X, Y codes) (Correct answer)
- ICD-10-CM codes for infectious diseases
Correct answer: External cause codes (V, W, X, Y codes)
External cause codes (V, W, X, Y codes) are among the categories exempt from POA reporting, as designated in CMS guidelines.
Question 7: What is the primary purpose of the POA reporting requirement for inpatient hospital claims?
- To increase hospital reimbursement through better documentation capture
- To distinguish conditions present at admission from those that are hospital-acquired (Correct answer)
- To simplify the MS-DRG assignment process for inpatient coders
- To eliminate the physician query process in inpatient facilities
Correct answer: To distinguish conditions present at admission from those that are hospital-acquired
The POA requirement enables identification of hospital-acquired conditions by distinguishing conditions present at admission from those that developed during the hospital stay.
CIC Present on Admission (POA) Indicators and Reporting 1
What does the POA indicator 'Y' represent in inpatient coding?