CIC Present on Admission (POA) Indicators and Reporting 2 — Questions and Answers
Question 1: Which POA indicator is assigned when the provider is clinically unable to determine whether a condition was present on admission or not?
- Y
- N
- U
- W (Correct answer)
Correct answer: W
POA indicator 'W' is used when clinical documentation indicates the provider cannot clinically determine whether the condition was present on admission.
Question 2: A patient is admitted for elective hip replacement. On post-operative day 2, a catheter-associated urinary tract infection (CAUTI) is diagnosed. What POA indicator applies to the CAUTI?
- Y — present at admission
- N — not present at admission (Correct answer)
- U — insufficient documentation
- W — clinically undetermined
Correct answer: N — not present at admission
Since the CAUTI developed after admission (post-op day 2), it was NOT present at admission, making POA indicator 'N' appropriate.
Question 3: Which of the following conditions is included in CMS's list of Hospital-Acquired Conditions (HACs)?
- Community-acquired pneumonia documented at the time of admission
- Surgical site infection following certain orthopedic procedures when not POA (Correct answer)
- Chronic obstructive pulmonary disease exacerbation present at admission
- Type 2 diabetes diagnosed prior to the current admission
Correct answer: Surgical site infection following certain orthopedic procedures when not POA
Surgical site infections following certain procedures are on CMS's HAC list and affect reimbursement when assigned a POA indicator of 'N.'
Question 4: POA indicator reporting is required on which type of claims?
- All outpatient facility claims submitted on the UB-04
- Inpatient prospective payment system (IPPS) hospital claims (Correct answer)
- Professional claims submitted on the CMS-1500 form
- All Medicare Part D prescription drug claims
Correct answer: Inpatient prospective payment system (IPPS) hospital claims
POA indicators are required on inpatient hospital claims subject to the IPPS, primarily Medicare Part A inpatient admissions.
Question 5: A patient is admitted via the emergency department following a motor vehicle accident. The external cause code for the accident would receive which POA indicator?
- Y — the accident clearly caused the admission
- N — the accident occurred before the patient arrived
- W — clinically undetermined
- 1 — exempt from POA reporting (Correct answer)
Correct answer: 1 — exempt from POA reporting
External cause codes (V, W, X, Y codes) are exempt from POA reporting and receive the indicator '1.'
Question 6: A patient is admitted with Type 2 diabetes. Chronic kidney disease Stage 3 is also documented, but the provider does not state whether it predates admission. What POA indicator is most appropriate while awaiting clarification?
- N — not documented as present at admission
- Y — the condition likely predates admission given its chronic nature
- U — insufficient documentation to determine POA status (Correct answer)
- W — clinically undetermined
Correct answer: U — insufficient documentation to determine POA status
When documentation is insufficient to determine whether a condition was present at admission, POA indicator 'U' is assigned, which may prompt a physician query.
Question 7: Under the MS-DRG system, what happens to DRG payment when a designated HAC is assigned a POA indicator of 'N'?
- The hospital receives a higher DRG payment to cover the additional care required
- CMS pays the MS-DRG as if the secondary diagnosis (HAC) were not present, reducing payment (Correct answer)
- The claim is automatically denied and must be resubmitted without the HAC code
- There is no financial impact — POA status only affects quality reporting metrics
Correct answer: CMS pays the MS-DRG as if the secondary diagnosis (HAC) were not present, reducing payment
When a HAC is not present on admission, CMS pays the lower MS-DRG that would have been assigned without that secondary diagnosis, removing the CC/MCC financial benefit.
CIC Present on Admission (POA) Indicators and Reporting 2
Which POA indicator is assigned when the provider is clinically unable to determine whether a condition was present on admission or not?