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DRG Pricing Calculator: Submitting an ICD-10 Claims Inquiry

October 19, 2015

Effective October 1, 2015, the Department of Health Care Services (DHCS) implemented the International Classification of Diseases, 10th Revision Clinical Modification (ICD-10-CM). All diagnosis-related groups (DRG) claims with discharge dates on or after October 1, 2015, should be coded with the new with the new ICD-10-CM or ICD-10-PCS (Procedure Coding System) codes. DHCS will be closely monitoring claims processing.

Prior to submitting an inquiry regarding a payment discrepancy, providers are encouraged to use the “SFY 15/16 DRG Pricing Calculator” located on the Diagnosis Related Group Hospital Inpatient Payment Methodology Web page, under the “Pricing Resources: SFY 2015/16” link to determine if the DRG claim is priced correctly.

It is recommended that providers check the Medi-Cal and DHCS websites regularly for updates.