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Back  RFI # 511: Present on Admission Indicator

Formal vs. Informal Help Informal Formal

Submitter

Stuart Barranco

Description

Per the DRA of 2005, by 10/1/2007, CMS is required to identify at least 2 high cost or high volume dx codes with a DRG assignment that has a higher payment weight when present with secondary dx. In order to group dx into the proper DRG, CMS needs to capture a Present On Admission (POA) indicator for all claims involving inpatient admissions to acute care hospitals. CMS believes the best way to accomplish this for claims submitted electronically via 837, 4010 format, will be to use segment K3 in the 2300 loop, data element K301. The element would contain the letters “POA”, followed by a single POA indicator for every dx reported on the claim. The POA indicator for the principal Dx should be the first indicator after “POA”. POA indicators for secondary dx would follow next if applicable. The last POA indicator must be followed by the letter “Z” to indicate the end of the data element or the letter “X” to indicate the end of the data element in future special data processing.

Submitter Assigned Keywords

POA present on admission 4010 K3 K301 diagnosis hospital

Response

ONLY applicable for version 4010. This solution does not apply to version 5010 (5010 solution - 2300 loop HI09 (yes/no Condition or Response Code) = Present on Admission.).

The 837 workgroup agrees with the use of K3 for the Present on Admission =business need. The POA must be reported in K3 segment in the 2300 loop, =data element K301 Positions 1-3= POA, Position 4= the POA indicator for the principal dx code.
Position 5 begins the reporting of POA indicators for all other dx codes =if applicable.
A "Z" or an "X" must be reported to indicate the end of reporting of the =POA indicators for the "other" dx codes. POA indicators are not =submitted for the admitting diagnosis code.
The byte following the "Z" or "X" value represents the POA indicator for =a submitted e-code if applicable. (See HIR 674 for instructions on =submitting multiple E-codes). If the segment ends in a "Z" or an "X" =value, then the e-code was not submitted.

Recommendation

Values for each byte are:
Y = Yes
N = No
U = unknown
W = clinically undetermined.
1- Represents a space or blank and means the dx code is exempt from =reporting of POA.
Z- Indicates the end of reporting of POA indicators for the other dx =codes.
X- Indicates the end of reporting of POA indicators for the other dx =codes when there are special processing situations.

Examples:
No E-code submitted
K3*POA1YNU1X~ Exception handling
K3*POA1YNU1Z~ No exception handling

A single E-code submitted
K3*POAYNUYZY~ No exception handling
K3*POAYNU1XY~ Exception handling

Multiple E-codes are submitted using BF qualifier:
HI*BK:41091*BJ:486*BN:E8120~ (Principle, admit and E-code) HI*BF:4019*BF:2859*BF:E9470*BF:E9270~ (two secondary diagnoses and two =additional E-code reported as a secondary diagnosis.)

K3*POAYYNNNXY~ exception handling
K3*POAYYNNNZY~ no exception handling
Submission 1/17/2007
Status Date 11/21/2008
Status F - Final
Primary References
Document 004010x096a1
SectionK3
Page262
Set ID837
Loop2300