Health Plan of San Joaquin (HPSJ) is here to help, however your practice must take steps to be ready for the change from ICD-9 to ICD-10 on October 1, 2015.

Prep Your Billing Service and/or Office Staff

Government regulations do not allow HPSJ to correct coding
errors or provide specific codes.
If you have any questions regarding billing with ICD-10
codes, please refer to the Medi-Cal website at:
http://files.medi-cal.ca.gov/pubsdoco/hipaa/hipaa_icd10_home.asp.

Process for any claim(s) denied for incorrect ICD code(s):
A corrected claim should be resubmitted. A Provider Dispute
should not be submitted for claim(s) denied for incorrect codes.

Clarification

Media reports about a delay in the start date of October 1, 2015 for ICD-10 implementation do not apply to provider practices.

Helpful Tip – “Family of codes”

Family of Codes is the same as the ICD-10 three-character category. This means that codes within a category are clinically related and provide differences in capturing specific information
on the type of condition. Examples include:

H25.031 (Anterior subcapsular polar age-related cataract, right eye), which has six characters
H25.22 (Age-related cataract, morgagnian type, left eye), which has five characters
H25.9 (Unspecified age-related cataract), which has four characters

Providers must report a valid code and not a category number. In many instances, the code will require more than 3 characters in order to be valid.

For more Helpful Tips, go to www.cms.gov/Medicare/Coding/ICD10/

If you have questions or need assistance, please call our Provider Services Department (209)942-6340.