Present-On-Admission (POA) indicator

Inpatient acute care hospitals paid under the TRICARE DRG-based payment system are required to report a Present-On-Admission (POA) indicator for both primary and secondary diagnoses on inpatient acute care hospital claims. POA is defined as present at the time the order for inpatient admission occurs.

Conditions that develop during an outpatient encounter, including emergency department, observation or outpatient surgery, are considered POA. Any hospital-acquired conditions, as identified by Medicare, will not be reimbursed. See list of hospital-acquired conditions

Any claim that does not report a valid POA indicator for each diagnosis on the claim will be denied.

The following hospitals are exempt from POA reporting for TRICARE:

  • Critical Access Hospitals (CAH)
  • Long-term care hospitals
  • Maryland waiver hospitals
  • Cancer hospitals
  • Children’s inpatient hospitals
  • Inpatient rehabilitation hospitals
  • Psychiatric hospitals and psychiatric units
  • Sole Community Hospitals (SCH)
  • US Department of Veterans Affairs (VA) hospitals

POA code descriptions

  • Y: Indicates that the condition was present on admission
  • W: Affirms that the provider has determined, based on data and clinical judgment, that it is not possible to document when the onset of the condition occurred.
  • N: Indicates that the condition was not present on admission
  • U: Indicates that the documentation is insufficient to determine whether the condition was present at the time of admission
  • 1: Prior to fiscal year 2011, signified exemption from POA reporting. The Centers for Medicare & Medicaid Services (CMS) established this code as workaround to blank reporting on the electronic 4010A1. A list of exempt ICD-9-CM diagnosis codes is available in the ICD-9-CM Official Coding Guidelines. This exemption to POA reporting is not available for reporting on the electronic 5010.

    As of fiscal year 2011, signifies unreported/not used. Exempt from POA reporting. (This code is equivalent to a blank on the CMS 1450 UB-04; however, it was determined that blanks are undesirable when submitting data via 4010A.)