The diagnosis does not match the procedure billed.
CO — Contractual obligation — the provider absorbs it and cannot bill the patient.
So the balance cannot move to the patient. Either the appeal recovers it or the practice absorbs it. That makes the appeal decision the whole decision on this line.
Fix and resubmit. This is a correction, not an appeal. Appealing burns the deadline.
In the order we see it.
The diagnosis does not support the procedure billed.
Recode from the chart and resubmit.
The documentation, not the argument.
A recode from what the record actually documents.
The common mistake. Do not appeal without rereading the note. If the coding was wrong, correcting it is faster than arguing.
Where this comes from. This is our own reading of the code, not the payer's and not a copy of the standards text. We classify it from how these denials actually resolve. Where we are unsure, we say so rather than guessing.
Send your denial summary for the last ninety days. Four columns: payer, CARC code, count, billed amount. I will tell you which were winnable and what they were worth.
Send your denial summary No patient data. No BAA. No charge.
AppealHound