MedicaidAdministrativeMedium impact
BT2024190: IHCP adds diagnosis codes to HAC/POA exception for inpatient hospital reimbursement
Indiana Medicaid (IHCP)·IN · Orthopedics, OB-GYN·Claims & Billing
Effective date
Dec 26, 2024
We identified it
Jun 19, 2026
Summary
Indiana Medicaid (IHCP) is adding 22 new diagnosis codes for embolism and thrombosis to the list of conditions exempt from hospital-acquired condition (HAC) and present-on-admission (POA) requirements for pediatric and obstetric patients after knee or hip replacement surgeries. This change aligns with CMS guidance and affects inpatient hospital reimbursement.
Action Required
By December 26, 2024: Hospital billing teams must update their systems to recognize the 22 new embolism and thrombosis diagnosis codes as exempt from HAC/POA requirements for pediatric and obstetric patients following knee or hip replacement surgeries. Ensure coding staff are aware these codes will not trigger HAC penalties when used appropriately for inpatient claims.