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Data Element Name:  Present on Admission Indicator
Format-Length:  A/N - 1 Required For:  IP
Effective Date:  1/1/94 Revision Date:  January 2008

NOTE: *This is a composite data element, for mapping guidelines refer to the Inpatient 837 Addendum.

**SPARCS prefers the X12-837 4050 Version, however if you are using the 4010 as prescribed by CMS for Medicare claims we will look in the K3 segment for this value, if it is not found in the HI segment.

National Standard Mapping:

Electronic - 837I

X12 Loop

Ref. Des.

Data Element

Code

Description
Version 4050R 2300 HI01-9 1073 Onset of Diagnosis Indicator

Version 4010AI** 2300 K301 449 Present on Admission Indicator

Paper Form Locator Code Qualifier
Institutional - UB-04 67 N/A

Definition:

A qualifier for each diagnosis coded under Other Diagnoses to indicate whether the onset of the diagnosis preceded or followed admission to the hospital.

Codes and Values:

  1. Y = Yes - Present at the time of inpatient admission

    N = No - Not present at the time of inpatient admission

    U = Unknown - Documentation is insufficient to determine if condition is present on admission

    W = Clinically Undetermined - Provider is unable to clinically determine whether condition was present on admission or not

    1 or blank = Exempt from POA reporting for selected ICD-9-CM codes

  2. If this field is not applicable it must be blank.

Example: HI*BF:99591:::::::N~

Edit Applications:

  1. If an Other Diagnosis Code 1-14 is reported, there must be a corresponding Present on Admission Indicator coded appropriately, except for E-codes.

  2. If Present on Admission Indicator is entered, Other Diagnosis Code 1-14 must also be reported.

  3. If Present on Admission Indicator is equal to 1 or blank, the associated Other Diagnosis Code 1-14 must be listed as an exempt code in the ICD-9-CM Reporting Guidelines.
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