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ICD-10-CM Diagnosis Codes Erroneously Denied for Radiology Claims

December 15, 2015

The Department of Health Care Services (DHCS) identified a claims processing issue causing some radiology claims to erroneously deny.

Claims are being erroneously denied for CPT-4 code 76514 (ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter; corneal pachymetry, unilateral or bilateral [determination of corneal thickness]) when billed with ICD-10-CM diagnosis code Q15.0 (congenital glaucoma).

Claims are also being erroneously denied for CPT-4 code 76800 (ultrasound, spinal canal and contents) when billed with ICD-10-CM diagnosis code Q76.49 (other congenital malformations of spine, not associated with scoliosis).

DHCS has corrected this issue. Providers should continue to submit claims in a timely manner. Affected claims will be reprocessed via an Erroneous Payment Correction (EPC). Providers are encouraged to check the Medi-Cal website regularly for updates.