POA indicators apply to all diagnosis codes for certain healthcare claims and clarify if the diagnosis was present at the time of admission. For example, did a fracture occur before the patient was admitted or during the patient's care? Or, did a decubitus ulcer (bed sore) occur before the patient was admitted or during the patient's stay?

The new UB-04 billing claim form allows the POA indicator when healthcare claims are sent to the health plan payer. Healthcare facilities, including general acute-care hospitals or other facilities that are subject to a law or regulation mandating the collection of POA, now have a mechanism to send this data to the health plan.

• 1992   NCVHS & UHDDS make a recommendation
• 1994  New York implements POA for public health reporting
• 1996  NCVHS Core Health Data make a recommendation
• 1996  California implements POA for public health reporting
• 1999  The Institute of Medicine publishes the report, “To Err is Human: Building a Safety Health System”
• 2000  CMC continues intense focus on employers and advocacy groups to restructure payment for healthcare based on quality of care delivered
• 2003  Consumer-Purchaser Disclosure Project proposed adding a quality indicator on the UB-04 form
• 2004  The NCVHS Workgroup on Quality make a recommendation to the HHS
• 2005  MEDPAC report was sent to Congress
• 2005  36 bills passed in 24 states related to health strategies to improve quality of patient care
• 2006  Provisions made in the DRA regarding hospital-acquired infections

• Joint effort between healthcare provider & coder to achieve complete & accurate documentation, code assignment & reporting of diagnosis/procedure
• Physician or any qualified healthcare provider legally accountable for establishing patient’s diagnosis
• Issues related to inconsistent, missing, conflicting, or unclear documentation must still be resolved by provider, hospital, facility, etc.
• If condition would not be coded & reported based on UHDDS definitions & current official coding guidelines, then the POA indicator would NOT be reported.

• Y & N: Must be explicitly documented, i.e. HPT, DM, Asthma.
• U: Assign when medical record documentation unclear. This should be only be used in very limited circumstances. Coders encouraged to query providers when documentation unclear.
• W: Assign when medical record documentation indicates that it cannot be clinically determined whether or not condition was POA.
• Assign Y for conditions that were clearly present, but not diagnosed, until after admission occurred. Dx subsequently confirmed after admission are considered POA if they are documented as suspected at the time of admission possible, or constitute an underlying cause of a symptom that is POA.