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Elizabeth M. Whitehorn, Director

Provider Notice 05/15/13

Attachment C Utilization Review Update for July 1, 2013

To:​ Participating Hospitals: Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers; and Health Information Management Directors (HIMDs)​
Date:​ May 15, 2013​
Re:​ Attachment C Utilization Review Update for July 1, 2013​

This update provides notification of additional admitting diagnosis codes that will be subject to admission/concurrent inpatient utilization review.

 

In consultation with the department's Quality Improvement Organization, eQHealth Solutions, the department will add six admitting diagnosis codes to Attachment C. Effective with inpatient admissions on and after July 1, 2013, the following admitting diagnosis codes are subject to mandatory concurrent review:

 

Admitting Diagnosis Code Diagnosis Description
285.9 Anemia, Unspecified
345.90 Epilepsy, Unspecified, Without Mention of Intractable Epilepsy
715.36 Osteoarthrosis, Localized, Not Specified Whether Primary or Secondary, Lower Leg
786.05 Shortness of Breath
787.01 Nausea with Vomiting
787.03 Vomiting Alone

 

There are no changes at this time to Attachments A, B, or D. Attachments A through D can be downloaded from the department's Peer Review Organization (PRO)/Quality Improvement Organization (QIO) website.

 

Any questions regarding the review process may be directed to eQHealth Solutions at the toll-free Helpline at 1-800-418-4045. Any questions regarding this notice may be directed to the Bureau of Quality Management at 217-557-5438.

 

Theresa A. Eagleson, Administrator
Division of Medical Programs