Loop 2300 HI/FL 67 | Medicare Billing: Form CMS-1450 and the 837 Institutional

Claims require the principal diagnosis, but using the POA indicator is only required by Inpatient Prospective Payment System (IPPS) hospitals.

Table 46: Loop 2300 HI/FL 67 field
Principal Diagnosis Code and Present on Admission Indicator	Source
Enter the ICD-10-CM diagnosis code for the principal diagnosis. Medicare accepts a Present on Admission (POA) indicator as the eighth digit of the principal diagnosis.	ICD-10-CM diagnosis code POA Indicator

Even though a patient may have another diagnosis more severe than the principal diagnosis, a facility should enter the principal diagnosis based on the reason chiefly responsible for an admission. If you enter any other diagnosis, you may get an incorrect payment. The code must be the full ICD-10-CM diagnosis code, including all 5 digits where applicable. Providers shouldn’t report the decimal in a diagnosis code because it’s unnecessary.

If hospitals don’t report a valid POA code for each diagnosis on the claim, CMS will return the claim to the hospital for correct submission of POA information.