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Reimbursement of Erroneous Denials for Pregnancy-Related Office Visit

February 3, 2016

A claims processing issue has been identified that can cause claims to erroneously deny when billed with HCPCS code Z1032 (initial comprehensive pregnancy-related office visit) and one of the following ICD-10-CM diagnosis codes:

ICD-10-CM Description
O30.021 Conjoined twin pregnancy, first trimester
O30.022 Conjoined twin pregnancy, second trimester
O30.023 Conjoined twin pregnancy, third trimester
O30.029 Conjoined twin pregnancy, unspecified trimester
O36.8210 Fetal anemia and thrombocytopenia, first trimester, unspecified
O36.8211 Fetal anemia and thrombocytopenia, first trimester, fetus 1
O36.8212 Fetal anemia and thrombocytopenia, first trimester, fetus 2
O36.8213 Fetal anemia and thrombocytopenia, first trimester, fetus 3
O36.8214 Fetal anemia and thrombocytopenia, first trimester, fetus 4
O36.8215 Fetal anemia and thrombocytopenia, first trimester, fetus 5
O36.8219 Fetal anemia and thrombocytopenia, first trimester, other
O36.8220 Fetal anemia and thrombocytopenia, second trimester, unspecified
O36.8221 Fetal anemia and thrombocytopenia, second trimester, fetus 1
O36.8222 Fetal anemia and thrombocytopenia, second trimester, fetus 2
O36.8223 Fetal anemia and thrombocytopenia, second trimester, fetus 3
O36.8224 Fetal anemia and thrombocytopenia, second trimester, fetus 4
O36.8225 Fetal anemia and thrombocytopenia, second trimester, fetus 5
O36.8229 Fetal anemia and thrombocytopenia, second trimester, other
O36.8230 Fetal anemia and thrombocytopenia, third trimester, unspecified
O36.8231 Fetal anemia and thrombocytopenia, third trimester, fetus 1
O36.8232 Fetal anemia and thrombocytopenia, third trimester, fetus 2
O36.8233 Fetal anemia and thrombocytopenia, third trimester, fetus 3
O36.8234 Fetal anemia and thrombocytopenia, third trimester, fetus 4
O36.8235 Fetal anemia and thrombocytopenia, third trimester, fetus 5
O36.8239 Fetal anemia and thrombocytopenia, third trimester, other
O36.8290 Fetal anemia and thrombocytopenia, unspecified trimester, unspecified
O36.8291 Fetal anemia and thrombocytopenia, unspecified trimester, fetus 1
O36.8292 Fetal anemia and thrombocytopenia, unspecified trimester, fetus 2
O36.8293 Fetal anemia and thrombocytopenia, unspecified trimester, fetus 3
O36.8294 Fetal anemia and thrombocytopenia, unspecified trimester, fetus 4
O36.8295 Fetal anemia and thrombocytopenia, unspecified trimester, fetus 5
O36.8299 Fetal anemia and thrombocytopenia, unspecified trimester, other fetus

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

ICD-10-CM codes O28.0 – O28.9 in conjunction with HCPCS code Z1032 will be removed from the provider manual with an effective date of October 1, 2015.