What information is needed when the hospital is being asked to provide the admitting diagnosis code and additional diagnosis codes at the time of admission?
Since it is the admitting diagnosis code that determines whether admission/concurrent review needs to be performed, it is very important that the admitting diagnosis be precise and that it is confirmed that the ICD-9-CM diagnosis code is listed on HFS Attachment A, B, or C. These attachments can be downloaded from HFS’ Web site at http://www.hfs.illinois.gov/proqio. If there are additional (secondary or principal) diagnoses, it is important that you provide those codes as well. Because the presence of other conditions may complicate the course of admission or influence the patients clinical status or treatment plan, HSI considers all of this information when assessing the medical necessity of admission or continued stay, the number of days that may be certified and the next review point. The complete clinical picture is necessary to ensure that complications and comorbid conditions are considered prior to rendering a review determination. Providing the ICD-9 codes will assist in ensuri
