Ms. Pinky Maniri Consulting Group

Ms. Pinky Maniri Consulting Group
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What is the meaning of the CMS Medicare Claim Denial Reason Code: CO-16, CO16, CO/16?

What is the meaning of the CMS Medicare Claim Denial Reason Code: CO-16, CO16, CO/16?

Reason Code Description: Claim/service lacks information which is needed for adjudication

This kind of rejection is very straightforward and is also easy to fix. You can get additional information about its denial by calling your local carrier's IVR (Interruptive Voice Response)

What to do:
1. Check if you have the right Medicare ID number
2. Check if you the procedure code needs a modifier (eg. LT, RT, 50)
3. Check if your diagnosis code requires a a 4th or 5th digit
4. Check if a referring physician on box 17 is required (don't forget its NPI!)
5. Check if your place of service is appropriate for your procedure code (eg. inpatient service is not billable with POS 11 (office based)!)

Please don't forget to always visit my Medical Billing, Coding and Office Management Website at www.justmypassion.com.

Thanks!

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My blog is for Informational, Communication, Training and Educational Purposes ONLY.

DISCLAIMER

CPT codes, descriptions and other data are copyrights, owned, maintained and are trademark of the AMA (American Medical Association).
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It is in NO way replaces the physicians' documented medical encounter and procedure rendered on the patient.

I do not provide legal and medical health services.
I am NOT an attorney or a physician.

I am not affiliated, working or in relation with any government agencies and offices such as the Center for Medicare and Medicaid Services and the OIG.

I am not affiliated, working or in relation to the American Medical Association.

I am not affiliated, working or in relation with any insurance companies, carriers including the third party payors.

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Always consult your local carrier's coverage determination, you insurance and 3rd party payor's policies and guidelines.

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