Priovider Notice Issued 01/02/2020

Date:         January 10, 2020
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 codes subject to inpatient utilization review in Attachment C. There are no changes to Attachments A, B, D, E, or F.
The ICD-10 code set was updated nationally effective October 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, 2019. No new coding categories are part of this utilization review update.
The table on the following page of this notice identifies the code extensions effective October 1, 2019. The extensions in Attachment C are subject to certification of admission/concurrent/continued stay review through the Department’s Quality Improvement Organization, eQHealth Solutions, Inc.
Diagnosis codes R11.13 and R11.14 were inadvertently left off Attachment C when the October 1, 2015 utilization review update was released. They are being included in Attachment C with this update.
The revised utilization review Attachment C is 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.
Doug Elwell
Medicaid Director



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