Medical Billing and Coding Resources
CO18 Denial Code: Duplicate Claim/Service Duplicate denials continue to be one of the top billing errors. It can be both counter-productive and costly for your practice, not to mention, they can end up getting you into trouble. Too many errors can result in the imposition of program integrity actions by the Medicare administrative contractor against […]
Why I am getting CO 4 Denial? CO 4 Denial Code: The procedure code is inconsistent with the modifier used or a required modifier is missing. You are receiving this reason code when a claim is submitted and the procedure code(s) are billed with the wrong modifier(s), or the required modifier(s) are missing. A clear […]
CO/PR 96: Non-covered charges At least one of Remark Code for CO 96 denial code must be provided: N425: Statutorily excluded N180 or N56: It indicates wrong Dx code was used on the claim for the CPT code Billed N115: It indicates that the claim was denied based on the LCD submitted M114: The Beneficiary […]
Basics of Denial Code CO 109 Denial Code CO 109 – Claim or Service not covered by this payer or contractor. You must send the claim/service to the correct payer/contractor. Denial Code CO 109 tells you that you might have a coordination of benefits (COB) issues to resolve. If you are getting a lot of […]
Basics of CO 197 CO 197 Denial Code: Precertification/authorization/notification absent. Some of the insurance companies request to obtaining prior authorization from them before the service/surgery. This may be required for certain specific procedures or may even be for all procedures. So, these are carrier-specific and procedure-specific. Please note that it is the responsibility of the […]
Basics of CO 45 Denial code CO 45: Charges exceed your contracted/legislated fee arrangement. Kindly note this adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. What is a Denial Code? Denial reason codes are […]
Basics of CO 16 CO 16 Denial Code: Claim/service lacks information which is needed for adjudication. Insurance will deny the claim with denial reason code CO 16 accompanied with remarks code, whenever claims submitted with missing, invalid, or incorrect information. The CO16 denial code alerts you that there is information that is missing in order […]
Basics of CO 97 No one likes to see a denied claim from an insurance payer. A denied claim is lost or delayed revenue for your practice. Nearly 65% of denied claims are never reworked by providers. Not only do you have to adhere to strict state-specific coding and audit guidelines, but you must also […]
