Notification: DRG Payment System Update to Mapper and Hospital Acquired Condition (HAC) v39.1 after April 1, 2022
April 26, 2022
Effective for dates of service on or after April 1, 2022, the Diagnosis Related Group (DRG) Program has updated the Medi-Cal payment system with the newest ICD-10-CM diagnosis and surgical procedure codes released by the Centers for Medicare & Medicaid Services (CMS) on April 1, 2022. Providers submitting claims using the new ICD-10-CM codes for admission dates before April 14, 2022 may have received a claim denial because the system update was not complete. Common claim denial Remittance Advice Details (RAD) codes are listed in the table below.
||The primary/secondary surgical procedure code has no match on the procedure file
||Diagnosis code missing or invalid
||APR-DRG – Valid all-patient refined (APR)-DRG code could not be determined
DRG recommends providers keep DRG claims timely. Medi-Cal will notify providers via ListSERV notification when the claims may be voided and resubmitted for payment.
For further DRG questions, please contact us at DRG@dhcs.ca.gov.