QI-Core Implementation Guide
6.0.0 - STU6 United States of America flag

This page is part of the Quality Improvement Core Framework (v6.0.0: STU6 (v6.0.0)) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

ValueSet: QICore Present On Admission Codes

Official URL: http://hl7.org/fhir/us/qicore/ValueSet/qicore-present-on-admission Version: 6.0.0
Draft as of 2021-05-14 Computable Name: QICorePresentOnAdmission

Value Set for QICore Present On Admission.

References

Logical Definition (CLD)

  • Include these codes as defined in https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Coding
    CodeDisplayDefinition
    YYesDiagnosis was present at time of inpatient admission. CMS will pay the CC/MCC DRG for those selected HACs that are coded as "Y" for the POA Indicator.
    NNoDiagnosis was not present at time of inpatient admission. CMS will not pay the CC/MCC DRG for those selected HACs that are coded as "N" for the POA Indicator.
    UUnknownDocumentation insufficient to determine if the condition was present at the time of inpatient admission. CMS will not pay the CC/MCC DRG for those selected HACs that are coded as "U" for the POA Indicator.
    WUndeterminedClinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission. CMS will pay the CC/MCC DRG for those selected HACs that are coded as "W" for the POA Indicator.
    1UnreportedUnreported/Not used. Exempt from POA reporting. This code is equivalent to a blank on the UB-04, however; it was determined that blanks are undesirable when submitting this data via the 4010A. CMS will not pay the CC/MCC DRG for those selected HACs that are coded as "1" for the POA Indicator. The “1” POA Indicator should not be applied to any codes on the HAC list. For a complete list of codes on the POA exempt list, see the Official Coding Guidelines for ICD-10-CM.

 

Expansion

Expansion based on codesystem CMS Present on Admission (POA) Indicator v07/14/2020 (CodeSystem)

This value set contains 5 concepts.

CodeSystemDisplayDefinition
  Yhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/CodingYes

Diagnosis was present at time of inpatient admission. CMS will pay the CC/MCC DRG for those selected HACs that are coded as "Y" for the POA Indicator.

  Nhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/CodingNo

Diagnosis was not present at time of inpatient admission. CMS will not pay the CC/MCC DRG for those selected HACs that are coded as "N" for the POA Indicator.

  Uhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/CodingUnknown

Documentation insufficient to determine if the condition was present at the time of inpatient admission. CMS will not pay the CC/MCC DRG for those selected HACs that are coded as "U" for the POA Indicator.

  Whttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/CodingUndetermined

Clinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission. CMS will pay the CC/MCC DRG for those selected HACs that are coded as "W" for the POA Indicator.

  1https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/CodingUnreported

Unreported/Not used. Exempt from POA reporting. This code is equivalent to a blank on the UB-04, however; it was determined that blanks are undesirable when submitting this data via the 4010A. CMS will not pay the CC/MCC DRG for those selected HACs that are coded as "1" for the POA Indicator. The “1” POA Indicator should not be applied to any codes on the HAC list. For a complete list of codes on the POA exempt list, see the Official Coding Guidelines for ICD-10-CM.

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code