Does a review request still need to be submitted if the patients admitting diagnosis is not reviewable, but a secondary or principle diagnosis is?
No, it is only the admitting diagnosis that determines if the hospitalization is subject to review. The admitting diagnosis is as defined in the UB-92/UB-04 Billing Manual. It is provided by the physician. It is recommended that the hospital submit its review request to HSI within 24 hours of the patients admission, or as soon thereafter as possible, if the admitting diagnosis is on HFS Attachment A, B, or C. Also HSI provides Coding Aids which list in numerical and alphabetical order the admitting diagnosis codes subject to review. The Coding Aids are posted on HSIs Web site.
