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Elizabeth M. Whitehorn, Director

Provider Notice issued 03/30/05

To: Enrolled Hospitals – Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers and Utilization Review Departments

Date: March 30, 2005

Re: Utilization Review – Deletion of Diagnosis and DRG Codes Subject to Review

 

The purpose of this notice is to inform hospitals of changes to diagnosis and DRG codes subject to utilization review. The changes will be effective with admissions occurring on and after May 1, 2005.

Explanation of Changes

HealthSystems of Illinois has conducted an analysis of codes subject to review and has noted that the denial rates associated with the review of some of these codes are low. Therefore, effective with admissions occurring on and after May 1, 2005, the department is eliminating the following codes from concurrent and/or prepayment review:

  • Attachment C Deletions – 518.81 (acute respiratory distress), 518.82 (other pulmonary insufficiency, not elsewhere classified) and 821.01 (fracture of femur shaft, closed).
  • Attachment D Deletions – DRG 098 (bronchitis and asthma, age 0-17 years) and DRG 410 (chemotherapy without acute leukemia).

This notice is located on the department’s Web site at:

 

                                    http://www.dpaillinois.com/hospitals/

 

Attachments A, B, C and D are located on the department’s Web site at:

 

                                    http://www.dpaillinois.com/proqio/

 

To reduce copying and mailing cost, the department may not always include hardcopies of attachments referenced in notices and bulletins. Web site links will be identified so providers may view and print the material from the Internet. Providers wishing to receive automatic E-mail notification of new provider information issued by the department, may register at the following Web site:

 

                                   http://www.dpaillinois.com/provrel/

 

Any questions regarding this notice may be directed to the Bureau of Maternal and Child Health Promotion at 217-524-7478.

 

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs