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
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 |
