A complete guide to Present on Admission (POA) indicators for ICD-10-CM coding. Learn the four POA values, which codes are exempt, and how POA affects Hospital-Acquired Condition (HAC) payment.
POA stands for Present on Admission. The POA indicator is a code attached to every diagnosis on an inpatient hospital claim that tells Medicare and other payers whether the condition was present when the patient was admitted to the hospital.
POA reporting was mandated by the Deficit Reduction Act of 2005 and became required for Medicare inpatient claims beginning in 2008. It was designed to prevent hospitals from being rewarded for hospital-acquired conditions — infections, injuries, or complications that develop during a patient's stay rather than being present at admission.
Why it matters: If a serious condition like a pressure ulcer or a central line infection is coded as present on admission, the hospital is not penalized. If it developed during the stay, it can result in reduced payment and public reporting of the complication.
| Indicator | Meaning | When to Use |
|---|---|---|
| Y | Yes — Present at admission | Condition was present at time of inpatient admission |
| N | No — Not present at admission | Condition developed after admission (hospital-acquired) |
| U | Unknown | Documentation insufficient to determine if present at admission |
| W | Clinically undetermined | Provider is unable to clinically determine whether condition was POA |
The Y indicator is by far the most common. N is reserved for conditions that clearly developed after the patient was admitted. U should be used sparingly — only when documentation is genuinely insufficient after a query attempt. W is for cases where the clinical picture itself is ambiguous regardless of documentation.
Not all ICD-10-CM codes require a POA indicator. CMS maintains a list of POA exempt codes — codes that by their nature are either not applicable to the POA concept or are always considered present on admission.
There are 8,071 POA exempt codes in the FY2026 dataset. These include:
ICD10Source flags all 8,071 POA exempt codes directly in search results. When you search a code, look for the blue POA Exempt badge — this tells you no POA indicator is required for that code on inpatient claims.
The POA program was specifically designed to address Hospital-Acquired Conditions. CMS maintains a HAC list of serious conditions that are reasonably preventable and that should not have been present at admission. When these conditions are coded with a POA indicator of N, the hospital may face payment reduction.
Current HAC categories include:
The official guidelines for POA reporting are part of the ICD-10-CM Official Guidelines for Coding and Reporting. Key points:
Query when uncertain: When documentation does not clearly support a Y or N determination, query the physician before defaulting to U. Excessive use of U can trigger audits and may indicate a documentation improvement opportunity.
The information in this guide is based on official U.S. government publications. Always verify coding information against the most current official sources before use in billing or clinical documentation.
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