Inpatient Hospital Sample Clauses

Inpatient Hospital. If you are an acute inpatient in a general or specialty hospital for behavioral health services, we cover medically necessary acute hospital services for detoxification. See Section 3.20 - Inpatient Hospital Services for additional information. Preauthorization is recommended.
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Inpatient Hospital. This measure calculates the utilization rate for general/acute inpatient services: the number of discharges per 1,000 member months. Newborn and mental health inpatient stays are excluded. Acute inpatient hospital services are identified by the following Type of Bill codes:11X, 12X, 41X, and 84X. Inpatient Hospital - Exclusions Newborns exclusions Mental Health and Chemical Dependency exclusions ICD-9 V codes ICD-9 Primary Diagnosis V30 – V39 Liveborn infants 290 to 316 Mental Disorders ICD-10 Z codes ICD-10 Primary Diagnosis Z37.0 – Z37.9 Outcome of delivery F0150 – F99 Mental, Behavior, and Neurodevelopmental disorders Z38.0 – Z38.8 Liveborn Infants G47.00, G47.9 Sleep Disorders; H9325 Central auditory processing disorder Q90, Q91, Q93.3 – Q93.7, Q93.88, Q93.89, Q93.9 Chromosomal abnormalities R37, R41.81, R41.840 – R41.844, R44.0, R44.2, R44.3, R45.0 – R45.7, R45.81, R45.82, R45.850, R45.851, R45.86 – R45.89, R46.81, R46.89, R48.0 – R48.1, R48.8 – R48.9, R54 Mental Disorders Z72.810 – Z72.811 Antisocial behavior Z87.890 Personal history of sex reassignment Z91.83 Wandering in diseases classified elsewhere Numerator: Discharges X 1,000 Discharges = encounters unduplicated by recipient ID and last date of the inpatient stay. Denominator: Member Months Data Source: Institutional Encounters Behavioral Health This measure calculates the behavioral health utilization rate: behavioral health visits per 1,000 member months. Emergency department visits for behavioral health diagnoses are included in this measure. A behavioral health visit is defined as a non-institutional behavioral health visit, an institutional outpatient behavioral health visit, or an institutional inpatient behavioral health stay. The encounters used to calculate the numerator are unduplicated by recipient ID and date of service. Codes to Identify Behavioral Health Services CPT ICD-9 Diagnosis and Procedure codes 90801 to 90899 Psychiatry 290 to 316 Mental Disorders HCPCS 960 to 979 Poisoning w/ secondary Dx of alcohol/drug psychoses, dependence, or abuse, alcoholic gastritis or alcoholic liver disease (291, 292, 303-305, 535.3, 571.1) T1015 w/ modifier U3*FQHC/Outpatient HealthFacility *Modifier can be in any of the four modifier positions on a claim. 94.26, 94.27, 94.61 to 94.69 ECT, Alcohol/drug rehab & detox ICD-10 Diagnosis and Procedure codes [See Inpatient Hospital Exclusions for BH Codes] T36-T39, T40-T49, T50 Poisoning w/ secondary Dx of alcohol/drug psychoses, dependence, or abuse,...
Sample 1

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