Resubmission of Claims Billed With ICD-10-CM Code N94.89

The Department of Health Care Service (DHCS) identified a claims processing issue affecting ICD-10-CM diagnosis code N94.89 (other specified conditions associated with female genital organs and menstrual cycle) claims billed with CPT codes 84702 (gonadotropin, chorionic [hCG]; quantitative) or 84703 (gonadotropin, chorionic [hCG]; qualitative). The issue caused claims to erroneously deny with Remittance Advice Details (RAD) codes 0169: This service is not payable when billed with this diagnosis, or 9109: This service is not payable for the diagnosis billed. The issue affected claims for dates of service from October 1, 2015, through July 14, 2016. No action is required on your part. Conduent will resubmit the affected claims. These resubmissions will appear on RAD forms beginning June 15, 2017, with Claim Control Number (CCN) roll number 55 (Resubmit). The roll number is the fifth and sixth digits of the CCN.

INDUSTRY NEWS TAGS: California Medi Cal

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