Update: Don’t use F codes when requesting prior authorization for inpatient medical admissions
We're updating an earlier news item to indicate that this information applies to prior authorization requests for BCN commercial members in addition to those for Medicare Advantage members.
When requesting authorization for acute care inpatient medical (non-behavioral health) admissions, select a medical ICD-10 diagnosis code in the e-referral system - one that doesn’t begin with F.
If you select an ICD-10 diagnosis code that begins with F, the processing of your request will be delayed because:
- You'll trigger a behavioral health questionnaire that you must complete.
- Your request will be routed to the incorrect department for review.
Background
We've noticed that for members admitted to a medical unit for acute detoxification (such withdrawal from alcohol or other drugs), providers are sometimes submitting authorization requests with diagnosis codes that begin with F.
However, these are considered medical - not behavioral health - admissions, even though the member's condition involves the use of alcohol or other substances.
Members this applies to
This applies to:
- BCN commercial members
- Medicare Plus BlueSM members
- BCN AdvantageSM members
Posted: April 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network