Who is affected by this change?

This affects Illinois Medicaid - HFS Psychiatry, Gastroenterology providers in IL on Medicaid plans.

When does this change take effect?

This change is effective Oct 1, 2016.

Utilization Review Update

Q: Which billing codes are affected?

The following codes are affected: F32.8, F32.81, F32.89, F34.8, F34.81, F34.89, F42, F42.2, F42.3, F42.4, F42.8, F42.9, F50.9, F64.0, F80.82, F50.8, F50.81, F50.89, K85.0, K85.00, K85.01, K85.02, K85.1, K85.10, K85.11, K85.12, K85.2.

Summary

ICD-10 diagnosis codes subject to inpatient utilization review have been updated with new expanded codes replacing deleted codes. Several codes have been moved between review categories and new prior authorization requirements take effect January 1, 2017.

Action Required

Action needed

Immediately: Billing team must update utilization review processes to use new expanded ICD-10 codes effective October 1, 2016. Contact eQHealth Solutions for any October/November discharges that received admission approval with deleted codes to update to expansion codes. For January 1, 2017: Update prior authorization processes for new Attachment F codes. Review revised Attachments A, B, E, and F on the Department's website.

Affected Billing Codes

F32.8

F32.81

F32.89

F34.8

F34.81

F34.89

F42

F42.2

F42.3

F42.4

F42.8

F42.9

F50.9

F64.0

F80.82

F50.8

F50.81

F50.89

K85.0

K85.00

K85.01

K85.02

K85.1

K85.10

K85.11

K85.12

K85.2

Related policy hubs

Illinois Medicaid - HFS policies IL policy changes Psychiatry Gastroenterology Code F32.8 Code F32.81 Code F32.89 Code F34.8 Code F34.81 Code F34.89 Code F42 Code F42.2 Code F42.3 Code F42.4 Code F42.8 Code F42.9 Code F50.9 Code F64.0 Code F80.82 Code F50.8 Code F50.81 Code F50.89 Code K85.0 Code K85.00 Code K85.01 Code K85.02 Code K85.1 Code K85.10 Code K85.11 Code K85.12 Code K85.2