Decoding Five Common Denial Codes in a Medical Practice

• 1 – Denial Code CO 11 – Diagnosis Inconsistent with Procedure.
• 2 – Denial Code CO 27 – Expenses Incurred After the Patient’s Coverage was Terminated.
• 3 – Denial Code CO 22 – Coordination of Benefits.
• 4 – Denial Code CO 29 – The Time Limit for Filing Already Expired.

What does denial code MA63 mean?

Missing/incomplete/invalid principal diagnosis
RARC MA63 (Missing/incomplete/invalid principal diagnosis.) The claim will be denied with: ▪ EX code 992 (Primary diagnosis is invalid for this setting.

How do you use modifier 66?

Claim Coding Example Since the kidney transplant was performed by a team of surgeons, modifier 66 is appended to the procedure code. Each surgeon reports the same procedure code with modifier 66. Procedure code 50365 has an indicator 2, which indicates that team surgery is permitted.

What is an explanatory code?

In certain circumstances, MSP may reject, reduce or refuse payment on a claim submitted by a health care practitioner. In each case, explanatory codes accompany the rejection, reduction or refusal in order to provide the practitioner with the reason for their claim not being paid in full.

What is Co 45 denial code?

CO 45 Denial Code – Charges exceed the fee schedule/maximum allowable or contracted/legislated fee arrangement. This CO 45 Denial code is denoted on the EOB/ERA from an insurance company, when the insurance plan contractually allowed amount is lesser than physician billed charges.

What is EOB in medical billing?

What is an Explanation of Benefits? An EOB is a statement from your health insurance plan describing what costs it will cover for medical care or products you’ve received. The EOB is generated when your provider submits a claim for the services you received.

What is modifier 66 used for?

Current Procedural Terminology (CPT®) modifier 66 describes when three or more surgeons of same or different specialties work together as primary surgeons performing distinct part(s) of a surgical procedure.

How do you call MSP?

Telephone: Call 1-800-661-2668 (toll-free in B.C.) or (250) 952-2657 (in Victoria). This is the automated TAP line at Health Insurance BC (HIBC) and the physician’s MSP Payee Number is required for entry. Facsimile: Fax your request to HIBC Provider Services at (250) 405-3592.