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Elizabeth M. Whitehorn, Director

Provider Notice Issued 12/07/2016

Utilization Review Update

​To: ​Participating Hospitals:  Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers, and Health Information Management Directors
​Date: ​December 7, 2016
​Re: ​Utilization Review Update

This update provides notification of changes to ICD-10 diagnosis and procedure coding subject to inpatient utilization review in Attachments A, B, E, and F.

The tables on the following pages of this notice identify new codes, as well as codes that have been deleted on the national level and replaced with expanded codes. The new and updated codes are subject to certification of admission/concurrent/continued stay review (Attachments A and B), prepayment review (Attachment E) and prior authorization review (Attachment F) through the Department’s Quality Improvement Organization, eQHealth Solutions, Inc.

The code expansions in Attachments A, B, and E are effective with admissions on and after October 1, 2016. The new codes selected for review in Attachment F will be effective for admissions on and after January 1, 2017. 

Code F50.9 has been moved from Attachment A to Attachment B to align it with other codes in its category. The ICD-10 update also includes numerous code description changes that have been incorporated into the Attachments.

Hospitals need to contact eQHealth regarding any inpatient stay with a discharge in October or November that received admission approval through eQHealth with one of the deleted codes. eQHealth will change the approved admitting diagnosis code to one of the expansion codes for dates of service beginning October 1, 2016. Any interim claim billed to the Department with an admission prior to October 1 but with a “From” date on or after October 1 should have an expansion code as the admitting diagnosis.

The revised utilization review Attachments A, B, E, and F are available on the

PRO/QIO page of the Department’s website.

Any questions may be directed to a billing consultant in the Bureau of Hospital and Provider Services at 1-877-782-5565.

 

 

Felicia F. Norwood

Director

 


Attachment A Changes Effective 10/01/16

Deletions

Additions

F32.8

F32.81

 

F32.89

F34.8

F34.81

 

F34.89

F42

F42.2

 

F42.3

 

F42.4

 

F42.8

 

F42.9

F50.9 (moved to Attachment B)

 

 

F64.0

 

F80.82

 

 

 

 

Attachment B Changes Effective 10/01/16

Deletions

Additions

F50.8

F50.81

 

F50.89

 

 

 

F50.9 (moved from Attachment A)

 

 

Attachment E Changes Effective 10/01/16

Deletions

Additions

K85.0

K85.00

 

K85.01

 

K85.02

K85.1

K85.10

 

K85.11

 

K85.12

K85.2