The procedure code was not valid on that date of service.
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 code was deleted or replaced in an annual update.
A new code was used before its effective date.
Check the code against the code set in force on the date of service, then rebill with the correct one.
The documentation, not the argument.
The procedure code valid on the date of service.
The common mistake. Do not use this year's code for an older date of service. Code to the date, not to today.
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