Five things to know about Present on Admission (POA) for hospital payment, quality

By Brian Murphy

Present on admission (herein POA) for coding purposes is defined as conditions that are present at the time the order for the inpatient admission occurs.

It’s important to get POA status right, as it impacts payment and quality metrics. POA conditions (as reported with a Y) count as CCs or MCCs, whereas conditions that develop in the hospital are not (these are healthcare acquired conditions, or HACs). Some commercial payers may vary.

Here are five things to keep in mind when reporting POA.

1. POA is more forgiving than you might believe. POA conditions can develop in an outpatient encounter, for example in your ED or during surgery, necessitating admission. These are still POA. POA does not mean a condition that occurred after passing the threshold of a hospital door; it’s the time of the IP order that matters. Cool.
2. It’s OK for your physicians to be uncertain and report uncertainty in their note (in fact, Y and N are for explicit documentation only). We have a POA status for that—W. W is clinically undetermined, reported when a provider is unable to clinically determine whether a condition is POA. Payment is made if the diagnosis is a HAC.
3. The ICD-10-CM Official Guidelines for Coding and Reporting contain a wealth of documentation scenarios for the many gray areas of POA, and thus should be reviewed at least annually. For example, of Codes that Contain Multiple Clinical Concepts, the guidelines state, “Assign “N” if at least one of the clinical concepts included in the code was not present on admission (e.g., COPD with acute exacerbation and the exacerbation was not present on admission; gastric ulcer that does not start bleeding until after admission; asthma patient develops status asthmaticus after admission).”
4. U (Unknown; documentation insufficient to determine POA status) should be used very sparingly. Your CDI team and/or coders should query the provider when the documentation is unclear. Excessive use of U should lead to focused documentation training and an effort to drive that rate down. Keep an eye on that.
5. No time frame is required for a provider to identify/document a condition as POA or no. Per the Official Coding Guidelines, it may not always be possible for a provider to immediately make a definitive diagnosis; alternatively, a patient may not recognize or report a condition until well into a patient’s admission. “In some cases, it may be several days before the provider arrives at a definitive diagnosis. This does not mean that the condition was not POA.”

How is your POA reporting? Do physicians understand the use and ramifications of U, or W? Any interesting POA scenarios?

Send me a question or comment to brian.murphy@norwood.com. Just don’t call me a PO*.

References

• ACDIS 2026 Pocket Guide
• ICD-10-CM Official Guidelines for Coding and Reporting (note: POA guidelines start on p. 116): https://www.cms.gov/files/document/fy-2026-icd-10-cm-coding-guidelines.pdf