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Elizabeth M. Whitehorn, Director

Provider Notice issued 11/30/09

Attachment C Utilization Review Changes

To:​

Participating Hospitals – Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers, and Utilization Review Departments​

Date:​ November 30, 2009​
Re:​

Attachment C Utilization Review Changes​

This informational notice provides notification of changes to diagnosis codes subject to admission/concurrent/continued stay inpatient utilization review. ICD-9-CM codes are routinely updated each year. Please note the following changes:

 

Changes in Diagnosis Codes on Attachment C

 

  • Effective with admissions on and after January 1, 2010, the following diagnosis codes are subject to mandatory concurrent review and will be added to Attachment C:
    • 453.50 Chronic venous embolism and thrombosis of unspecified deep vessels of lower extremity
    • 453.51 Chronic venous embolism and thrombosis of deep vessels of lower of proximal lower extremity
    • 453.52 Chronic venous embolism and thrombosis of deep vessels of lower of distal lower extremity
    • 453.6 Venous embolism and thrombosis of superficial vessels of lower extremity
    • 453.71 Chronic venous embolism and thrombosis of superficial veins of upper extremity
    • 453.72 Chronic venous embolism and thrombosis of deep veins of upper extremity
    • 453.73 Chronic venous embolism and thrombosis of upper extremity, unspecified
    • 453.74 Chronic venous embolism and thrombosis of axillary veins
    • 453.75 Chronic venous embolism and thrombosis of subclavian veins
    • 453.76 Chronic venous embolism and thrombosis of internal jugular veins
    • 453.77 Chronic venous embolism and thrombosis of other thoracic veins
    • 453.79 Chronic venous embolism and thrombosis of other specified veins
  • The following code has been deleted from Attachment C effective October 1, 2009, as ICD-9-CM coding guidelines now require a 5th digit for billing:
    • 453.8 Deep vein thrombosis (DVT), venous embolism and thrombosis of other specified veins (venous thrombosis NEC), other
  • The following codes are new 5th digit extensions of the previously reviewable Code 453.8, and as such, were automatically reviewable effective October 1, 2009:
    • 453.81 Acute venous embolism and thrombosis of superficial veins of upper extremity
    • 453.82 Acute venous embolism and thrombosis of deep veins of upper extremity
    • 453.83 Acute venous embolism and thrombosis of upper extremity, unspecified
    • 453.84 Acute venous embolism and thrombosis of axillary veins
    • 453.85 Acute venous embolism and thrombosis of subclavian veins
    • 453.86 Acute venous embolism and thrombosis of internal jugular veins
    • 453.87 Acute venous embolism and thrombosis of other thoracic veins
    • 453.89 Acute venous embolism and thrombosis of specified veins
  • The following codes are currently subject to mandatory concurrent review in Attachment C, but the ICD-9-CM descriptions have been revised. Since the codes were already reviewable, the description changes were effective October 1, 2009:
    • 453.40 Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity
    • 453.41 Acute venous embolism and thrombosis of deep vessels of lower of proximal lower extremity
    • 453.42 Acute venous embolism and thrombosis of deep vessels of lower of distal lower extremity

There are no changes at this time to Attachments A, B and D. All of the attachments can be downloaded from the department's PRO/QIO Web site.

 

Department notices are available at the Provider Releases Web site.

 

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 Maternal and Child Health Promotionat 217-557-5438.

 

Theresa A. Eagleson, Administrator
Division of Medical Programs