Provider Notice issued 11/15/02

Changes to the Ambulatory Procedures Listing (APL)

This update is notification that a revised Ambulatory Procedures Listing (APL) of outpatient-billable ICD-9-CM procedure codes is available on the Department's website. The code changes associated with this APL are effective for dates of service on or after October 1, 2002. The APL is contained in Appendices H-4 and H-5 of the Handbook for Hospitals and Appendix 4 of the Handbook for Ambulatory Surgical Treatment Centers (ASTC).

A significant change contained in this update is that the Department will no longer identify non-covered surgical procedures for the ASTC setting. An ASTC may perform any surgical procedure approved by the individual facility's Consulting Committee and authorized by the Department of Public Health under Administrative Rules 77 Ill. Adm. Code 205.130. The non-covered indicators for the ASTC setting have been removed from the APL.

In addition, changes have been made to the following sections of the APL:  

•  Appendix H-4b identifies 23 ICD-9-CM procedure codes added effective for dates of service on and after October 1, 2002. 

•  Appendix H-4c lists all APL procedures in group order. Additions are identified in bold print. 

• Appendix H-4d lists all APL procedures in procedure code order. Additions are identified in bold print. 

• Appendix H-5 is the Inpatient Procedures Requiring Justification list. One code has been added to the list. These procedures, when performed on an inpatient basis, are no longer subject to prepayment review, but may be subject to retrospective post-payment review by the Department's contracted peer review organization.

The APL is available at <http://www.dpaillinois.com/reimbursement/apl.html>. The documents are in Adobe Portable Document Format (PDF). In order to view or print the documents, you will need to have Adobe Acrobat Reader installed on your computer. Adobe Acrobat Reader is available to download FREE from the Adobe homepage at <http://www.adobe.com>.

Paper copies of the APL may be obtained by contacting the Bureau of Comprehensive Health Services at (217) 782-5565. Files of the APL are also available in machine-readable format. These files may be obtained by sending a blank formatted DS/DD or DS/HD 3.5 inch IBM PC compatible diskette along with a self-addressed and prepaid diskette mailer to:

Illinois Department Healthcare and Family Services
Bureau of Comprehensive Health Services
Attn:  Billing and Payment Section
P.O. Box 19128
Springfield, Illinois  62794-9128 

Please include a telephone number and the name of a contact person with your request.

INSTRUCTIONS FOR UPDATING THE HANDBOOKS:

For the Handbook for Hospitals, replace Appendices H-4a through H-5 in their entirety with revised Appendices H-4a through H-5 dated October 2002.

For the Handbook for Ambulatory Surgical Treatment Centers, replace Appendix 4 in its entirety with revised Appendices H-4a through H-4e dated October 2002.