Diagnosis Present on Admission Indicator 4

SAS Name
DGNS_POA_IND_4

A code to indicate that the diagnosis (in DGNS_CD_1-12 fields) was present at the time the order for inpatient admission (POA) occurred.

Comments

POA indicator is used to identify certain preventable conditions that are: 

(a) high cost or high volume or both,

(b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and

(c) could reasonably have been prevented through the application of evidence- based guidelines.

*States that do not use the grouper methodology may use CMS- approved methodology that is prospective in nature.

There is a POA indicator code associated with each diagnosis code (principal and secondary).

Source: T-MSIS Analytic File (TAF) Claims

Code Code value
Y Diagnosis was present at time of inpatient admission
N Diagnosis was not present at time of inpatient admission
U Documentation insufficient to determine if condition was present at the time of inpatient admission
W Clinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission
1 Unreported/Not used. Exempt from POA reporting
Null/missing source value is missing, unknown, or not on the valid value list or within the range of valid values