ICD-9 Specificity Billing Modification for Mar. 2005

Current Medi-Cal policy requires providers to bill using the highest level of diagnosis code available on a given date of service. Effective January 01, 2005, claims billed with an invalid diagnosis code will be returned. The code must provide the highest level of specificity available in order to be valid. For example, if a provider bills with a 3–digit diagnosis code when a 4–digit or 5–digit diagnosis code is available, the 3–digit code is considered invalid and the claim will be returned. This policy does not apply to medical transportation claims.