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Provider Quick Tips #245: All Patient Refined-Diagnosis Related Group (APR- DRG) to be Updated with COVID-19 Billing Codes 

Issued: April 30, 2020

The Department of Human Services (Department) will implement Version 37.1 R1 of the APR-DRG classification system for Medical Assistance (MA) Program enrolled acute care general hospitals that provide services to beneficiaries in the MA Fee-For-Service delivery system. This will affect acute care general inpatient stays with discharge dates on or after April 1, 2020. 

However, until that version is available and loaded into PROMISeTM, submitted claims with a discharge date on or after April 1, 2020 may deny if COVID-19 codes are included. 

The Department will notify providers of the implementation of COVID-19 diagnosis codes and subsequent mass adjustment of submitted claims which include these codes. 

The Department will begin to mass adjust claims submitted for discharge dates from April 1, 2020 through implementation at a date to be determined. These adjustments will be reflected on a future Remittance Advice.