General Question for the Week of June 27, 2016

General Compliance Question of the Week


Can you provide guidelines related to assignment of the POA indicator on Medicare claims?


The “UB-04 Data Specifications Manual” and “Official Guidelines” can help you assign the present-on-admission (POA) indicator for each “principal” diagnosis and “other” ICD-10-CM diagnosis codes reported on the UB-04 (paper claims) and ASC X12N 837 Institutional (837I) (electronic transmissions).

More information about the “UB-04 Data Specifications Manual” can be found at The Centers for Medicare & Medicaid Services (CMS) emphasize that the manual is not intended to replace any guidelines in the main body of the “Official Guidelines” or provide guidance on when to report a condition. It simply provides information on how to apply the POA indicator to the diagnosis codes assigned.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.