The Most Common Medical Billing Denial Codes And Reasons

The Most Common Medical Billing Denial Codes And Reasons

Medical billing involves some complex and elaborate process that might cause some differences and error. The processes are different depending on each procedure, patient, and insurer. The most reputable financial services departments even experience billing denials. Therefore, it is important to know and understand the most common medical billing denial codes and reasons to take some actions to avoid them.

The medical billing denial codes and reasons appear to communicate why a claim has been adjusted or modified. If there are no any adjustments or modifications, there will not be these codes. The letters at the beginning of the codes such as CO, CR, and PR identifies the segment. Here are 4 common medical billing denial codes and reasons to learn about.

4 Common Medical Billing Denial Codes and Reasons

  • Denial Code CO 97

The reason why this denial released is because the procedures or services are not paid separately. In this case, you need to know that the service billings might have been submitted as parts of another billed service for the same date. For example, the E/M services that have been conducted during the post-surgery period that are related to the surgery are considered not paid separately.

  • Denial Code M-15

This denial code is released because separate payment is not allowed for the billed services or tests that have been bundled since they are considered as components with the same procedures. The separate payment will not be made for routinely bundled supplies and services. The bundled services should be billed only if the denial is needed for a secondary payer. The bundled services in this case often come in several related denial codes; 97010 (hot/cold packs), 94760 (Noninvasive Oximetry), 99100 (Special anesthesia services), A4500 (surgical tray), and 99071 (Educational Supplies).

  • Denial Code M-144

This code means that the allowance for the provided surgery has covered the pre or post-operative care payment. Before and after surgery services or procedures costs are included in the approved amount for the services. Evaluation and management (E/M) services associated with the surgery and conducted during the post-surgery period is considered not paid separately.

If the billing for care service is separated, please coordinate the billing activities with the separated cares to the other provider involved in the patient’s care and make sure that the surgical code is billed before the provider bill the post- surgery services. If the claim is modified, apply the appropriate modifier and resubmit the claim by submitting the corrected line only. Don’t resubmit the entire claim since it causes a duplicate claim denial. The modifiers usually come in 3 code forms: 54 (pre and during operative services performed), 55 (post-operative management services only), and 56 (pre-operative services only).

  • Denial Code N70

The claim date of service is included in the first and last dates of patient’s home health service period. Before giving service to the customer or Medicare beneficiary, please determine if the period of home health exist.  Ensure to check the eligibility of the beneficiary before submitting the claims to the Medicare.

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