Provider Notice Issued 11/30/2018

Date:         November 30, 2018
 
To:            Participating Hospitals:  Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers, and Health Information Management Directors
 
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. There are no changes to Attachments C and D.
 
Although the ICD-10 code set was updated nationally effective October 1, 2018, new ICD-10 codes selected for utilization review will be effective with admissions on and after January 1, 2019. Per HFS utilization review policy, codes that are extensions of existing codes that were subject to review are automatically subject to review, and these extensions were effective October 1, 2018.
 
The tables on the following pages of this notice identify new codes, deleted codes, code extensions, and codes with description changes. The new codes in Attachments A and B are subject to certification of admission/concurrent/continued stay review through the Department’s Quality Improvement Organization, eQHealth Solutions, Inc.
 
The national ICD-10 update includes the deletion of select back surgery procedure codes found on Attachment F. If a hospital received prior authorization October 1st through November 30th using one of the deleted codes, they must contact eQHealth to provide another reviewable procedure code on Attachment F.
 
 The revised utilization review Attachments A, B, E, 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.
 
 
Teresa T. Hursey
Medicaid Director

Attachment A
Changes
 
New Code
Effective 01/01/19
Description Changes Effective 10/1/18
F68.A
F68.10
 
F68.11
 
F68.12
 
 
Attachment B
New Codes
Effective 01/01/19
 
F12.23
F12.93
 
 
Attachment E
Changes Effective 10/01/18
 
Deleted Code
Code Extensions
K35.89
K35.890
 
K35.891
 
 
Attachment F
Procedure Code Deletions (96) Effective 10/01/18
 
0RG10Z0
0RG40Z1
0RG70ZJ
0RGA3Z0
0SG13Z1
0RG10Z1
0RG40ZJ
0RG73Z0
0RGA3Z1
0SG13ZJ
0RG10ZJ
0RG43Z0
0RG73Z1
0RGA3ZJ
0SG14Z0
0RG13Z0
0RG43Z1
0RG73ZJ
0RGA4Z0
0SG14Z1
0RG13Z1
0RG43ZJ
0RG74Z0
0RGA4Z1
0SG14ZJ
0RG13ZJ
0RG44Z0
0RG74Z1
0RGA4ZJ
0SG30Z0
0RG14Z0
0RG44Z1
0RG74ZJ
0SG00Z0
0SG30Z1
0RG14Z1
0RG44ZJ
0RG80Z0
0SG00Z1
0SG30ZJ
0RG14ZJ
0RG60Z0
0RG80Z1
0SG00ZJ
0SG33Z0
0RG20Z0
0RG60Z1
0RG80ZJ
0SG03Z0
0SG33Z1
0RG20Z1
0RG60ZJ
0RG83Z0
0SG03Z1
0SG33ZJ
0RG20ZJ
0RG63Z0
0RG83Z1
0SG03ZJ
0SG34Z0
0RG23Z0
0RG63Z1
0RG83ZJ
0SG04Z0
0SG34Z1
0RG23Z1
0RG63ZJ
0RG84Z0
0SG04Z1
0SG34ZJ
0RG23ZJ
0RG64Z0
0RG84Z1
0SG04ZJ
0SG70ZZ
0RG24Z0
0RG64Z1
0RG84ZJ
0SG10Z0
0SG73ZZ
0RG24Z1
0RG64ZJ
0RGA0Z0
0SG10Z1
0SG74ZZ
0RG24ZJ
0RG70Z0
0RGA0Z1
0SG10ZJ
0SG80ZZ
0RG40Z0
0RG70Z1
0RGA0ZJ
0SG13Z0
0SG83ZZ
 
 
 
 
0SG84ZZ
 

Notices

 

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