Healthcare billing
POA Indicators: How Present-on-Admission Status Impacts MS-DRG Reimbursement
A diagnosis can be a valid MCC and still not raise your MS-DRG — if it developed during the stay. The deciding factor is the Present-on-Admission (POA) indicator, a one-character code reported on nearly every inpatient diagnosis.
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What POA indicators mean
POA reports whether each diagnosis was present at the time the inpatient admission order was written. Four values plus blank: Y, N, U, W; leave the indicator blank for exempt codes (the older 4010 value “1” is no longer used).
| Code | Meaning |
|---|---|
Y | Present on admission. |
N | Not present on admission (i.e., it developed during the stay). |
U | Documentation is insufficient to determine whether it was present on admission. |
W | The provider is clinically unable to determine whether it was present on admission. |
| blank | Exempt from POA reporting (a defined list of diagnoses, such as certain external-cause and status codes). The older 4010 value 1 is no longer used. |
Where POA changes the payment: the HAC provision
Under Medicare's Hospital-Acquired Conditions (HAC) payment provision, a defined list of conditions will not be allowed to act as a CC or MCC when they are coded as not present on admission (POA = N or U). The logic: Medicare will not pay a hospital more for a serious complication the hospital caused.
Representative conditions on the HAC list include (among others):
- Foreign object retained after surgery
- Air embolism and blood incompatibility (ABO)
- Stage III and IV pressure ulcers
- Falls and trauma resulting in serious injury
- Catheter-associated urinary tract infection (CAUTI)
- Vascular catheter-associated infection
- Certain surgical site infections and manifestations of poor glycemic control
If one of these is the only CC/MCC on the case and it is coded POA = N or U, the grouper treats the case as though that condition were not a CC/MCC — dropping it from the "with MCC/CC" DRG to the lower-severity DRG, and lowering payment accordingly.
Illustration. Suppose the sole MCC on an admission is a Stage IV pressure ulcer coded POA = N (it developed in-house). Under the HAC provision it can't act as an MCC, so a case that would have grouped to the "with-MCC" DRG instead groups "without" — the same drop in relative weight described in CC vs MCC, driven entirely by the POA code.
Why accurate POA coding matters
- Don't lose legitimate severity: a genuinely pre-existing condition coded POA = Y correctly preserves the higher-severity DRG.
- "U" is a documentation gap, not a shortcut: a U is treated like N for HAC purposes — a query to the provider is usually the right move.
- Quality reporting: POA data also feeds public HAC and patient-safety measures, so accuracy affects both payment and reputation.