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Notice: Effective December 1, 2009, Blue Cross and Blue Shield of North Carolina (BCBSNC) to require "Present on Admission" indicator for UB-04 inpatient claims


Beginning 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:

  • Y = The condition was present on admission.
  • W = The provider has determined, based on data and clinical judgment, that it is not possible to document when the onset of the condition occurred.
  • N = The condition was not present on admission.
  • U = Documentation is insufficient to determine if the condition was present at the time of admission.
  • 1 = Used on 4010A1 and 5010 versions of the 837 to represent a space or a blank and means the Diagnosis Code is exempt from reporting POA.

(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