Claims Processing Issue for Elderly Multigravida ICD-10 Codes

Effective retroactively for dates of service on or after October 1, 2015, the Department of Health Care Services (DHCS) has identified a claims processing issue causing claims to erroneously deny when billed with ICD-10 diagnosis codes O09.521 – O09.523 (elderly multigravida). This issue affected claims for the following CPT codes: 76801- 76817 Ultrasound, pregnant uterus, real time with image documentation. Providers should continue to submit claims in a timely manner. Affected claims will be reprocessed via an Erroneous Payment Correction (EPC).