Medi-Cal – Resubmission of Erroneously Denied Claims for Select ICD-10 Diagnosis Codes

The Department of Health Care Services (DHCS) identified a claims processing issue affecting claims for select International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes. This issue caused claims to erroneously deny with the following Remittance Advice Details (RAD) codes:

• 9516: The secondary diagnosis code is missing or invalid for procedure code; and
• 0169: This service is not payable when billed with this diagnosis.

The issue affected claims for dates of service from October 1, 2022, through May 11, 2023.

Source: https://files.medi-cal.ca.gov/pubsdoco/epc/2023/32318_p44429.pdf