Clarification: Don’t use F codes when requesting prior authorization for inpatient medical admissions

We’re clarifying an article published in the March 2021 issue of The Record to indicate that this information applies to prior authorization requests for BCN commercial members in addition to 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 as withdrawal from alcohol or other drugs), providers are sometimes submitting authorization requests with diagnosis codes that begin with F.

However, these are considered medical admissions — even if the member’s condition involves the use of alcohol or other substances.

Members this applies to

This applies to:

• BCN commercial members
• Medicare Plus Blue^SM members
• BCN Advantage^SM members