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    Denial Codes

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    shyam
    This document lists and defines common denial codes used in medical billing, including codes for when procedures are inconsistent with modifiers, diagnoses don't match procedures, claims are missing required information, claims are duplicates, expenses occurred after coverage ended, services aren't deemed medically necessary, charges are non-covered, and claims weren't submitted to the correct payer. It provides explanations for denial codes frequently encountered in medical billing.

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    Denial Codes

    Uploaded by

    shyam
    548 views1 page
    This document lists and defines common denial codes used in medical billing, including codes for when procedures are inconsistent with modifiers, diagnoses don't match procedures, claims are missing required information, claims are duplicates, expenses occurred after coverage ended, services aren't deemed medically necessary, charges are non-covered, and claims weren't submitted to the correct payer. It provides explanations for denial codes frequently encountered in medical billing.

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    Denial codes

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    This document lists and defines common denial codes used in medical billing, including codes for when procedures are inconsistent with modifiers, diagnoses don't match procedures, claims are missing required information, claims are duplicates, expenses occurred after coverage ended, services aren't deemed medically necessary, charges are non-covered, and claims weren't submitted to the correct payer. It provides explanations for denial codes frequently encountered in medical billing.

    Copyright:

    © All Rights Reserved
    Download as TXT, PDF, TXT or read online from Scribd
    Download as txt, pdf, or txt
    548 views1 page

    Denial Codes

    Uploaded by

    shyam
    This document lists and defines common denial codes used in medical billing, including codes for when procedures are inconsistent with modifiers, diagnoses don't match procedures, claims are missing required information, claims are duplicates, expenses occurred after coverage ended, services aren't deemed medically necessary, charges are non-covered, and claims weren't submitted to the correct payer. It provides explanations for denial codes frequently encountered in medical billing.

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    © All Rights Reserved
    Download as TXT, PDF, TXT or read online from Scribd
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    CO 4 Denial Code – The procedure code is inconsistent with the modifier used or a

    required modifier is missing

    CO 11 Denial Code – The diagnosis is inconsistent with the procedure

    CO 16 Denial Code – Claim or Service Lacks Information which is needed for


    adjudication

    CO 18 Denial Code – Duplicate Claim or Service

    CO 22 Denial Code – This care may be covered by another payer per coordination of
    benefits

    CO 24 Denial Code – Charges are covered under a capitation agreement or managed


    care plan

    CO 27 Denial Code – Expenses incurred after coverage terminated

    CO 29 Denial Code – The time limit for filing has expired

    CO 50 Denial Code – These are non-covered services because this is not deemed
    medical necessity by the payer

    CO 96 Denial Code – Non-Covered Charges

    CO 97 Denial Code – The benefit for this service is included in the payment or
    allowance for another service or procedure that has already been adjudicated

    CO 109 Denial Code – Claim or Service not covered by this payer or contractor, you
    must send the claim or service to the correct payer or contractor

    These are some of the important Denial reason codes, which we come across regularly
    and it’s been explained along with solutions.

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