Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 2 - Medical Guidelines › Chapter 25 - Hospital Reimbursement Schedule, Billing Instruction and Maintenance Procedures › Section I-2519 - Outlier Reimbursement and Appeals Procedures

Current through Register Vol. 50, No. 6, June 20, 2024
A. Automatic Outliers. Inpatient hospital
				  acute care services falling within certain diagnosis code ranges will be
				  reimbursed outside the normal per diem reimbursement method. These atypical
				  admissions will be paid at covered billed charges less a 15 percent discount.
				  Conditions requiring acute care inpatient hospital services that are
				  work-related and are recognized as "automatic outliers" are:
1. AIDS: ICD-10 diagnosis code B20;
2. Acute Myocardial Infarction: ICD10
				  diagnosis codes: I213, I214, I220, I221, I222, I228, I229; I2101, I2102, I2109,
				  I2111, I2119, I2121, I2129; and
3.
				  severe burns: ICD-10 diagnosis codes: T2030XA, T20311A, T20312A, T20319A,
				  T2032XA, T2033XA, T2034XA, T2035XA, T2036XA, T2037XA, T2039XA, T2070XA,
				  T20711A, T20712A, T20719A, T2072XA, T2073XA, T2074XA, T2075XA, T2076XA,
				  T2077XA, T2079XA; T2130XA, T2131XA, T2132XA, T2133XA, T2134XA, T2135XA,
				  T2136XA, T2137XA, T2139XA, T2170XA, T2171XA, T2172XA, T2173XA, T2174XA,
				  T2175XA, T2176XA, T2177XA, T2179XA; T2230XA, T22311A, T22312A, T22319A,
				  T22321A, T22322A, T22329A, T22331A, T22332A, T22339A, T22341A, T22342A,
				  T22349A, T22351A, T22352A, T22359A, T22361A, T22362A, T22369A, T22391A,
				  T22392A, T22399A, T2270XA, T22711A, T22712A, T22719A, T22721A, T22722A,
				  T22729A, T22731A, T22732A, T22739A, T22741A, T22742A, T22749A, T22751A,
				  T22752A, T22759A, T22761A, T22762A, T22769A, T22791A, T22792A, T22799A;
				  T23301A, T23302A, T23309A, T23311A, T23312A, T23319A, T23321A, T23322A,
				  T23329A, T23331A, T23332A, T23339A, T23341A, T23342A, T23349A, T23351A,
				  T23352A, T23359A, T23361A, T23362A, T23369A, T23371A, T23372A, T23379A,
				  T23391A, T23392A, T23399A, T23701A, T23702A, T23709A, T23711A, T23712A,
				  T23719A, T23721A, T23722A, T23729A, T23731A, T23732A, T23739A, T23741A,
				  T23742A, T23749A, T23751A, T23752A, T23759A, T23761A, T23762A, T23769A,
				  T23771A, T23772A, T23779A, T23791A, T23792A, T23799A; T24301A, T24302A,
				  T24309A, T24311A, T24312A, T24319A, T24321A, T24322A, T24329A, T24331A,
				  T24332A, T24339A, T24391A, T24392A, T24399A, T24701A, T24702A, T24709A,
				  T24711A, T24712A, T24719A, T24721A, T24722A, T24729A, T24731A, T24732A,
				  T24739A, T24791A, T24792A, T24799A; T25311A, T25312A, T25319A, T25321A,
				  T25322A, T25329A, T25331A, T25332A, T25339A, T25391A, T25392A, T25399A,
				  T25711A, T25712A, T25719A, T25721A, T25722A, T25729A, T25731A, T25732A,
				  T25739A, T25791A, T25792A, T25799A; T2600XA, T2601XA, T2602XA, T2610XA,
				  T2611XA, T2612XA, T2620XA, T2621XA, T2622XA, T2630XA, T2631XA, T2632XA,
				  T2640XA, T2641XA, T2642XA, T2650XA, T2651XA, T2652XA, T2660XA, T2661XA,
				  T2662XA, T2670XA, T2671XA, T2672XA, T2680XA, T2681XA, T2682XA, T2690XA,
				  T2691XA, T2692XA; T270XXA, T271XXA, T272XXA, T273XXA, T274XXA, T275XXA,
				  T276XXA, T277XXA; T281XXA, T282XXA, T283XXA, T2840XA, T28411A, T28412A,
				  T28419A, T2849XA, T285XXA, T286XXA, T287XXA, T288XXA, T28911A, T28912A,
				  T28919A, T2899XA; T300; T304; T310, T320; T3110, T3210; T3111, T3211; T3120.
				  T3220; T3121, T3221; T3122, T3222; T3130, T3230; T3131, T3231; T3132, T3232;
				  T3133, T3233; T3140, T3240; T3141, T3142, T3143, T3243; T3144, T3244; T3150,
				  T3250; T3152, T3252; T3151, T3251; T3154, T3254; T3153, T3253; T3155, T3255;
				  T3160, T3260; T3161, T3261; T3162, T3262; T3163, T3263; T3164, T3264; T3165,
				  T3265; T3166, T3266; T3170, T3270; T3171, T3271; T3172, T3272; T3173, T3273;
				  T3174, T3274; T3175, T3275; T3176, T3276; T3177, T3277; T3180, T3280; T3181,
				  T3281; T3182, T3282; T3183, T3283; T3184, T3284; T3185, T3285; T3186, T3286;
				  T3187, T3287; T3188, T3288; T3190, T3290; T3191, T3291; T3192, T3292; T3191,
				  T3293; T3194, T3294; T3196, T3296; T3195, T3295; T3197, T3297; T3198, T3298;
				  T3199, T3299.