Important NewsNotice: Effective December 1, 2009, Blue Cross and Blue Shield of North Carolina (BCBSNC) to require "Present on Admission" indicator for UB-04 inpatient claimsBeginning December 1, 2009, Blue Cross and Blue Shield of North Carolina (BCBSNC) will require that all UB-04 inpatient general acute care hospital claims include a "present on admission" (POA) indicator for every diagnosis reported. This policy change is effective for admissions on or after December 1, 2009. Providers must report POA indicators to BCBSNC in Field 67 (A-Q) of the UB-04, the same way they are reported to the Centers for Medicare & Medicaid Services (Visit the HAC POA [hospital-acquired conditions present on admission] Web page at http://www.cms.hhs.gov/HospitalAcqCond/ on the CMS Web site) and in accordance with the UB-04 Data Specifications Manual and ICD-9-CM Official Guidelines for Coding and Reporting. The five POA indicator reporting options are:
(If filing a paper UB-04, leaving the field blank designates POA as unreported, not used or exempt from POA reporting). The POA indicator is used to note that a condition is present at the time the order for inpatient admission occurs. It is noted by using one of the five values listed above, which record whether secondary diagnoses are present when a patient is admitted. POA indicators allow conditions acquired during a patient's inpatient stay to be reported. In the event that a patient's condition is hospital-acquired and were to result in a serious adverse event, the facility should refrain from billing for services associated with the serious adverse event (based on severity of condition and if determined to be reasonably preventable), as outlined in the BCBSNC policy for *Nonpayment for Serious Adverse Events. BCBSNC policy for Nonpayment for Serious Adverse Events can be viewed on the Web or downloaded from: http://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/nonpay ment_for_serious_adverse_events.pdf |