DHCS Adds New COVID-19-Related Codes to the Diagnosis-Related Group Methodology, Retroactively to April 1

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The Department of Health Care Services (DHCS) recently announced the incorporation of new Centers for Medicare & Medicaid Services-approved ICD-10-CM and ICD-10-PCS codes related to COVID-19 into the diagnosis-related group inpatient hospital payment methodology, retroactively to April 1.   

The following diagnosis and procedure codes will now be reflected in the methodology of determining a hospital’s specific bundled episodic rate: 

An erroneous payment correction will be implemented to reprocess affected claims with dates of service on or after April 1, 2022. Providers may also elect to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Medi-Cal Provider Manual.