Resubmission of Erroneously Denied Laboratory Services Claims -Lipid Panel

The Department of Health Care Services (DHCS) identified a claims processing issue affecting some laboratory services claims billed with CPT code 80061 (lipid panel). This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 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 July 23, 2007, through September 30, 2015 (for claims billed with ICD-9-CM diagnosis codes V70.0 and V70.8), and for dates of service from October 1, 2015, through June 27, 2016 (for claims billed with ICD-10-CM diagnosis codes Z00.00 and Z00.8). No action is required on your part. Conduent resubmitted the affected claims. These resubmissions began appearing on RAD forms beginning July 6, 2017, with Claim Control Number (CCN) prefix 717955.

INDUSTRY NEWS TAGS: California Medi Cal

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