Texas Prior Authorization Program Clinical Edits Agents for Gaucher’s Disease July 31, 2015 Copyright © 2015 Health Information Designs, LLC 72 Step 2 (diagnosis of Pregnancy)
April 3, 2015 Copyright © 2012 Health Information Designs, LLC 1 Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Valturna Agents
Texas Prior Authorization Program Clinical Edits Agents for Gaucher’s Disease July 31, 2015 Copyright © 2015 Health Information Designs, LLC 72 Step 2 (diagnosis of Pregnancy)
Yes No Yes No Yes Yes No No Yes Yes Step 1 Is the client ≥ 18 years of age? Yes Deny Request Step 2 Does the client have a diagnosis of hypertension in the last 365 days? Deny R
40390 HYP REN NOS W/O REN FAIL Hypertension, complicated 40391 HYP REN NOS W REN FAIL Hypertension, complicated 40400 . 64223 OLD HYPERTEN NEC-ANTEPAR Hypertension, complicated 64224 OLD HYPERTEN NEC-POSTPAR Hypertension, complicated 64270 TOX W OLD HYPERTEN-UNSP Hypertension, complicated 64271 TOX W OLD HYPERTEN-DELIV Hypertension, complicated
Old Hyperten Nec-antepar: 642.24: Old Hyperten Nec-postpar: 642.3: Transient hypertension of pregnancy (gestational hypertension) 642.30: Trans Hyperten Preg-unsp: 642.31: Trans Hyperten-delivered: 642.32: Trans Hyperten-del W P/p: 642.33: Transient hypertension with antepartum condition or complications: 642.34: Trans Hyperten-postpart: 642.4: Mild or unspecified preeclampsia: 642.40: Mild/nos Preeclamp-unsp: 642.41: Mild/nos Preeclamp-deliv:
ICD-9 Code: ‘64513’ Diagnosis - Post term preg-antepar (Post term pregnancy, antepartum condition or complication)
OLD HYPERTEN NEC-ANTEPAR 642.24 OLD HYPERTEN NEC-POSTPAR 642.30 TRANS HYPERTEN PREG-UNSP 642.33 TRANS HYPERTEN-ANTEPART 642.34 TRANS HYPERTEN-POSTPART 642.40 MILD/NOS PREECLAMP-UNSP 642.43 MILD/NOS PREECLAMP-ANTEP 642.44 MILD/NOS PREECLAMP-P/P 642.50 SEVERE PREECLAMP-UNSPEC . 1Appendix A.1 ICD-9-CM Code Tables 1Specifications Manual for National Hospital Inpatient Quality Measures
HCUP Methods Series Comorbidity Software Documentation : Report #2004-1 : Contact Information: Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality http://www.hcup-us.ahrq.gov . OLD HYPERTEN NEC-ANTEPAR: Hypertension, complicated: 64224: OLD HYPERTEN NEC-POSTPAR: Hypertension, complicated: 64270: TOX W OLD HYPERTEN-UNSP: Hypertension, complicated: 64271: TOX W OLD HYPERTEN-DELIV: Hypertension, complicated: 64272:
ICD-9: 642.24 Short Description: Old hyperten NEC-postpar Long Description: Other pre-existing hypertension,complicating pregnancy, childbirth, and the puerperium, , postpartum condition or complication This is the 2014 version of the ICD-9-CM diagnosis code 642.24 Code Classification. Complications of pregnancy, childbirth, and the puerperium