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

Notices

 

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