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Denial Codes
Reasons for claim rejections
| Question | Answer |
|---|---|
| -24 | UNRELATED E/M service, by same physician, during POST-OP period. Used with CPT grps: E/M |
| -25 | Significantly, Separately Identifiable service, by same physician on same day as procedure. Use with CPT grp: E/M |
| -32 | Mandated Service by third party carrier/gov't agency. Use to identify mandated consultations; commonly used with Work Comp Disability. Use with CPT grps: ALL |
| -50 | Bilateral procedure (same procedure on both R & L side). Used w/ CPT codes: E/M, Surgery, Radiology, Medicine |
| -52 | Reduced service (when complete service not performed). Use w/ CPT grps: E/M, Surgery, Radiology, Path/Lab, Medicine |
| -55 | Post-Op care only (when other physician does surgery). Used w/ CPT code: Surgery, Medicine |
| -57 | Decision for Surgery (E/M svc performed day prior or day of surgery. Used w/ CPT codes: E/M |
| -59 | Distinct Procedural Service. Used when medically necess procedures are performed together, that are not normally done at same time. Used for CPT codes: Anesthesia, Surgery, Radiology, Path/Lab, Medicine. |
| -62 | Two Surgeons (working both as primary surgeons). Used w/ CPT codes: Surgery, Radiology |
| -99 | Multiple Modifiers. Used when more than 2 modifiers are needed to describe a service. Use w/ CPT grps: ALL |
| CO | Contractual Obligation |
| CR | Correction and Renewal used for correcting a prior claim |
| OA | Other Adjustment: used when no other code applies to the adjustment. |
| PR | Patient Responsibility |
| Code 1 (CARC)-claim adj. reason | Deductible Amount |
| Code 2 (CARC)-claim adj. reason | Coinsurance Amount |
| Code 3 (CARC)-claim adj. reason | Copayment amt |
| Code 4 (CARC)-claim adj. reason | Procedure code inconsistent with the modifier used or the required modifier is missing. |
| Code 5 (CARC)-claim adj. reason | The procedure code/bill type is inconsistent w/ place of svc. |
| 96 (CARC)-claim adj. reason | NON-COVERED charge |
| Code 40 (CARC)-claim adj. reason | Charges do not meet qualifications for emergent/urgent care. |
| RARC M1 | X-ray not taken within the past 12 months or near enough to the time of TX |
| RARC M2 | Not paid separately when the pt. is an inpatient. |
| RARC M3 | Equipment is the same or similar to equipment already being used. |
| RARC M4 | Alert: This is the latest monthly installment for a piece of equipment being used. |
| RARC M125 | Missing/incomplete/invalid information on the period of time that the supply/service/equipment will be needed. |
| RARC N1 | Alert: You may appeal this decision in writing after receiving this notice. |
| RARC N24 | Missing/incomplete/invalid electronic fund transfer. |
| Provider-level adj. code 50 | Late charge |
| Provider-level adj. code 51 | Interest penalty charge Used to identify the interest assessment for late filing. |
| Provider-level adj. code 72 | Authorized return (refund to an institutional provider from a previous overpayment). |
| Provider-level adj. code 90 | Early payment allowance. Used to indicate when this has occurred. |
| RARC | Remittance Advice Remark Codes Further explain the reason for a payment adjustment. Used w/ claims adj. reason codes. |
| CARC | Claims Adjustment Reason Codes Provide financial information about claims decisions. Any payment adjustment must be accompanied by claims adjustment reason codes. |
| Group Codes Definition | Identify the party financially responsible for a specific svc or the gen'l category of pmt adjustment. |
| Provider-level adjustment reason codes | Are not related to a specific claim. These adjustments are made by a providers office. |
Created by:
awesomeMaralyn
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