On Oct. 3, the Department of Health Care Services notified hospital providers that the diagnosis-related group (DRG) program has updated the Medi-Cal fee-for-service (FFS) payment system with the newest ICD-10-CM diagnosis and surgical procedure codes released by the Centers for Medicare & Medicaid Services, effective on or after Oct. 1, 2023.
Providers submitting FFS claims using the new ICD-10-CM codes for admission dates before Oct. 1 may have received a claim denial because the system update was not complete at the time of claim submission. Common claim denial remittance advice details codes are listed in the table below. If you have received a denial with one of these codes, please resubmit your claim.
|67||The primary/secondary surgical procedure code has no match on the procedure file|
|9124||Diagnosis code missing or invalid|
|9962||APR-DRG – Valid APR-DRG Code could not be determined|
To prevent delays in claim adjudication, Present On Admission indictors should be included on submitted claims.
For further DRG questions, please contact us at DRG@dhcs.ca.gov.