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February 27, 2009

Discontinuance of Occurrence Codes 53 (Mother's Discharge Date) and 58 (Level II or Level III Perinatal)

The Illinois Department of Healthcare and Family Services issued an informational notice to advise hospitals reimbursed by the per diem reimbursement methodology of a change in billing requirements. It does not impact hospitals reimbursed by the Diagnosis-Related Group (DRG) payment system. Pursuant to UB claim form coding guidelines, Occurrence Codes 53 and 58 are no longer valid. Effective with admissions on and after April 1, 2009, the department will no longer utilize Occurrence Codes 53 and 58 for claim payment determination. In processing claims, the department groups all inpatient claims to a DRG, regardless of payment methodology. Claims with admissions on and after April 1, 2009, that group to DRG 391 will be paid at zero. Claims with admissions on and after April 1, 2009, that group to any other valid DRG will continue to be paid based upon the hospital’s per diem rate.