Agencies
Services
Provider Notice issued 10/1/08
To: Participating Hospitals – Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers, and Utilization Review Departments
Date: October 1, 2008
Re: Attachments B and C Utilization Review Update for November 1, 2008
This informational notice provides notification of changes to diagnosis codes subject to admission/concurrent inpatient utilization review.ICD-9-CM codes are routinely updated each year. The following changes are effective with admissions on and after November 1, 2008.
Changes in Diagnosis Codes on Attachment B
Effective with admissions on and after November 1, 2008, Diagnosis Code 293.0 is subject to mandatory concurrent review and will be added to Attachment B:
293.0 Delirium due to conditions classified elsewhere
Changes in Diagnosis Codes on Attachment C
Effective with admissions on and after November 1, 2008, the descriptions of the following diagnosis codes subject to mandatory concurrent review will be revised in Attachment C:
038.11 Methicillin susceptible Staphylococcus aureus septicemia
MSSA septicemia
Staphylococcus aureus septicemia NOS707.00 Pressure ulcer, unspecified site
707.01 Pressure ulcer, elbow
707.02 Pressure ulcer, upper back
707.03 Pressure ulcer, lower back
707.04 Pressure ulcer, hip
707.05 Pressure ulcer, buttock
707.06 Pressure ulcer, ankle
707.07 Pressure ulcer, heel
707.09 Pressure ulcer, other site
707.10 Ulcer of lower limb, except pressure ulcer, unspecified
707.11 Ulcer of thigh, except pressure ulcer
707.12 Ulcer of calf, except pressure ulcer
707.13 Ulcer of ankle, except pressure ulcer
707.14 Ulcer of heel and midfoot, except pressure ulcer
707.15 Ulcer of other part of foot, except pressure ulcer
707.19 Ulcer of other part of lower limb, except pressure ulcer
Effective with admissions on and after November 1, 2008, the following diagnosis codes are subject to mandatory concurrent review and will be added to Attachment C:
250.12 Diabetes with ketoacidosis, type II or unspecified type, uncontrolled
250.20 Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled
250.21 Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled
250.22 Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled
250.23 Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled
535.70 Eosinophilic gastritis without mention of hemorrhage
535.71 Eosinophilic gastritis with hemorrhage
707.20 Pressure ulcer, unspecified stage
Healing pressure ulcer NOS
Healing pressure ulcer, unspecified stage
707.21 Pressure ulcer, Stage IHealing pressure ulcer, Stage I
Pressure pre-ulcer skin changes limited to persistent focal erythema707.22 Pressure ulcer, Stage II
Healing pressure ulcer, Stage II
Pressure ulcer with abrasion, blister, partial thickness skin loss involving epidermis and/or dermis707.23 Pressure ulcer Stage III
Healing pressure ulcer, Stage III
Pressure ulcer with full thickness skin loss involving damage or necrosis of subcutaneous tissue707.24 Pressure ulcer Stage IV
Healing pressure ulcer, Stage IV
Pressure ulcer with necrosis of soft tissues through to underlying muscle, tendon or bone707.25 Pressure ulcer, unstageable
There are no changes at this time to Attachments A and D.All of the attachments can be downloaded from the department’s Web site at:
<http://www.hfs.illinois.gov/proqio/>.
As a reminder from the previous informational notice dated May 1, 2008, when a diagnosis code is subject to review and ICD-9-CM coding guidelines mandate a coding change requiring a 4th or 5th digit code extension, the 4th or 5th digit extension will automatically be subject to review. Department notices are available at:
<http://www.hfs.illinois.gov/releases/>.
References for the changes can be found at:
<http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm>.
Any questions regarding the review process may be directed to HealthSystems of Illinois (HSI) at the toll-free Helpline at 1-800-418-4045.Any questions regarding this notice may be directed to the Bureau of Healthcare Quality Improvement at 217-557-8269.
Theresa A. Eagleson, Administrator
Division of Medical Programs