CIC Present on Admission (POA) Indicators and Reporting 2

Question 1

Which POA indicator is assigned when the provider is clinically unable to determine whether a condition was present on admission or not?

Accepted Answer

W

Answer

Y

Answer

N

Answer

U

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?

Accepted Answer

N — not present at admission

Answer

Y — present at admission

Answer

U — insufficient documentation

Answer

W — clinically undetermined

Question 3

Which of the following conditions is included in CMS's list of Hospital-Acquired Conditions (HACs)?

Accepted Answer

Surgical site infection following certain orthopedic procedures when not POA

Answer

Community-acquired pneumonia documented at the time of admission

Answer

Chronic obstructive pulmonary disease exacerbation present at admission

Answer

Type 2 diabetes diagnosed prior to the current admission

Question 4

POA indicator reporting is required on which type of claims?

Accepted Answer

Inpatient prospective payment system (IPPS) hospital claims

Answer

All outpatient facility claims submitted on the UB-04

Answer

Professional claims submitted on the CMS-1500 form

Answer

All Medicare Part D prescription drug claims

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?

Accepted Answer

1 — exempt from POA reporting

Answer

Y — the accident clearly caused the admission

Answer

N — the accident occurred before the patient arrived

Answer

W — clinically undetermined

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?

Accepted Answer

U — insufficient documentation to determine POA status

Answer

N — not documented as present at admission

Answer

Y — the condition likely predates admission given its chronic nature

Answer

W — clinically undetermined

Question 7

Under the MS-DRG system, what happens to DRG payment when a designated HAC is assigned a POA indicator of 'N'?

Accepted Answer

CMS pays the MS-DRG as if the secondary diagnosis (HAC) were not present, reducing payment

Answer

The hospital receives a higher DRG payment to cover the additional care required

Answer

The claim is automatically denied and must be resubmitted without the HAC code

Answer

There is no financial impact — POA status only affects quality reporting metrics