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Elizabeth M. Whitehorn, Director

Provider Notice Issued 10/17/2017

​

 

Date:         October 17, 2017

To:            Participating Hospitals:  Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers, and Health Information Management Directors

 

Re:            Utilization Review Update Effective December 1, 2017

 

 

This update provides notification of changes to ICD-10 diagnosis and procedure coding subject to inpatient utilization review in Attachments A, B, C, and F. There are no changes to Attachments D and E.

 

Although the ICD-10 code set was updated nationally effective October 1, 2017, new ICD-10 codes selected for utilization review will be effective with admissions on and after December 1, 2017. The Department’s Quality Improvement Organization, eQHealth Solutions, Inc., discontinued prior authorization review of those nationally deleted procedure codes that were on Attachment F effective October 1, 2017.    

 

The tables on the following pages of this notice identify new codes, deleted codes, and codes with description changes. The new codes in Attachments B and C are subject to certification of admission/concurrent/continued stay review through eQHealth Solutions, Inc.

 

Hospitals need to contact eQHealth regarding any inpatient stay with a discharge after October 1, 2017 for which prior authorization was received for a back surgery with one of the deleted codes from Attachment F. eQHealth will change the prior authorization approved code so that the billed claim will process correctly.

 

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

PRO/QIO page of the Department’s website.

 

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 Change Effective 10/01/17

 

Description Change

F41.0

 

 

Attachment B Changes Effective 12/01/17

 

New Codes

F10.11

F11.11

F12.11

F13.11

F14.11

F15.11

F16.11

F18.11

F19.11

F50.82

 

 

Attachment C Changes

 

New Codes

Effective 12/01/17

 

Description Changes Effective 10/01/17

E11.10

L97.215

L97.508

L98.416

I50.1

E11.11

L97.216

L97.515

L98.418

I82.811

I21.9

L97.218

L97.516

L98.425

I82.812

I21.A1

L97.225

L97.518

L98.426

I82.819

I21.A9

L97.226

L97.525

L98.428

 

I50.810

L97.228

L97.526

R06.03

 

I50.811

L97.305

L97.528

 

 

I50.812

L97.306

L97.805

 

 

I50.813

L97.308

L97.806

 

 

I50.814

L97.315

L97.808

 

 

I50.82

L97.316

L97.815

 

 

I50.83

L97.318

L97.816

 

 

I50.84

L97.325

L97.818

 

 

I50.89

L97.326

L97.825

 

 

L97.105

L97.328

L97.826

 

 

L97.106

L97.405

L97.828

 

 

L97.108

L97.406

L97.905

 

 

L97.115

L97.408

L97.906

 

 

L97.116

L97.415

L97.908

 

 

L97.118

L97.416

L97.915

 

 

L97.125

L97.418

L97.916

 

 

L97.126

L97.425

L97.918

 

 

L97.128

L97.426

L97.925

 

 

L97.205

L97.428

L97.926

 

 

L97.206

L97.505

L97.928

 

 

L97.208

L97.506

L98.415

 

 

 

Attachment F Procedure Code Changes Effective 10/01/17

 

Deletions

 

0RG10A1

0RG13A1

0RG14A1

0RG20A1

0RG23A1

0RG24A1

0RG40A1

0RG43A1

0RG44A1

0RG60A1

0RG63A1

0RG64A1

0RG70A1

0RG73A1

0RG74A1

0RG80A1

0RG83A1

0RG84A1

0RGA0A1

0RGA3A1

0RGA4AJ

0SG00A1

0SG03A1

0SG04A1

0SG10A1

0SG13A1

0SG14A1

0SG30A1

0SG33A1

0SG34A1