22-1026 Inpatient Hospital Claims Affected Because New ICD-10 Codes Not Released

Date: 12/02/22

Health Net to pay now and adjust later when rates are released

In October of each calendar year, the Department of Health Care Services (DHCS) issues to plans new diagnosis codes (DX) for inpatient claims and relevant pricing for these codes.

Since the DHCS has not yet released the rates associating the new DX codes with diagnostic-related groups (DRGs), we will begin processing impacted inpatient claims to ensure timely payments to our hospitals based on available rates.

We will make necessary adjustments to these payments once the DHCS releases the new pricing information, when appropriate.

How will I know if a claim was adjusted for payment?

Claims that are adjusted for payment will include the following note on the explanation of payment: “10/1/22 – New ICD-10 code adjustment.”

Example

Below are examples of new DX and DRG codes where pricing has not yet been received. Note: The codes noted are examples only. The list is not all-inclusive.

DX Code	DRG Code	DRG Description
Z20822	560	Aftercare, musculoskeletal system and connective tissue with complication or comorbidity.
Z20822	540	Osteomyelitis with complications or comorbidity
Z20822	566	Other musculoskeletal system and connective tissue diagnoses without complication or comorbidity (CC)/major complication or comorbidity (MCC)

If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center within 60 days at 800-675-6110.

 

This information applies to Hospitals.

For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.