CHA News Article

APR-DRG Billing Code Updates Available
Included are type of bill 121, services to infants and organ donors

The California Department of Health Care Services (DHCS) has released All Patient Refined Diagnosis Related Group (APR-DRG) billing code updates for July. Medi-Cal has fixed an issue with inpatient claims so that, beginning July 1, claims billed with type of bill 121 will no longer be erroneously denied with remittance advice details (RAD) code 9952. Starting July 14, providers should resubmit DRG type of bill 121 claims with dates of service on or after July 1, 2013, through June 30, 2014.

Timeliness requirements are being waived for these claims, so providers do not need to submit a delay reason code or any other documentation. The timeliness waiver will allow for claim resubmission until Sept. 26. In addition, DHCS has issued new requirements for other DRG electronic claims, effective retroactively for dates of service on or after July 1, 2013.

For DRG electronic claims that include services to an infant that are billed using the mother’s ID number, the claim must indicate “baby using mother’s ID” in the NTE segment of the 837I v.5010 electronic claim. DRG electronic claims billed for organ donation services must indicate “donor using recipient’s ID” in the NTE segment. Claims billed without the required statements will be denied. For more information about electronic claim submission, see the HIPAA 5010 Medi-Cal Companion Guide.