How do I fix or resolve code 112?

Review the medical record thoroughly to confirm the service was documented as furnished directly to the patient on the date of service billed. If the documentation exists but was not submitted with the claim, submit the supporting documentation (office note, operative note, or treatment note) via the payer portal or 275 attachment transaction. If the documentation is insufficient — for example, the note does not mention the patient by name, does not describe the service rendered, or lacks a provider signature — obtain an addendum from the rendering provider clarifying the service. File a formal appeal with the complete medical record, a letter explaining the service was furnished directly to the patient, and any additional documentation that supports the encounter. If the service was not actually rendered to the patient (e.g., a billing error or a service ordered but not performed), withdraw the claim and refund any payment received.

112Denial CodeGeneral Adjustment

Code 112

Problem Description

Service not furnished directly to the patient and/or not documented.

Root Cause

The service was not furnished directly to the patient and/or was not documented in the medical record. The payer denied the claim because the documentation does not support that the service was actually provided to the patient — for example, a service billed for a patient who was not present, a service rendered to a non-patient (e.g., a family member), or a service that was ordered but not performed. The payer may have conducted a pre-payment or post-payment audit and found insufficient documentation to verify the service was furnished. This is a documentation and medical necessity denial — the provider must prove the service was rendered directly to the patient.

Resolution Steps

1Review the medical record thoroughly to confirm the service was documented as furnished directly to the patient on the date of service billed.
2If the documentation exists but was not submitted with the claim, submit the supporting documentation (office note, operative note, or treatment note) via the payer portal or 275 attachment transaction.
3If the documentation is insufficient — for example, the note does not mention the patient by name, does not describe the service rendered, or lacks a provider signature — obtain an addendum from the rendering provider clarifying the service.
4File a formal appeal with the complete medical record, a letter explaining the service was furnished directly to the patient, and any additional documentation that supports the encounter.
5If the service was not actually rendered to the patient (e.g., a billing error or a service ordered but not performed), withdraw the claim and refund any payment received.

EHR Documentation Note

Claim denied 112 — service not furnished to patient or not documented; reviewed medical record, submitted supporting documentation, or filed appeal with complete encounter notes.

Preventative Action

Ensure all clinical documentation includes the patient's name, the date of service, a description of the service rendered, and the provider's signature, and conduct periodic documentation audits to verify claim supportability.

Related Codes in General Adjustment

Deductible Amount

Coinsurance Amount

Co-payment Amount

The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

This directory provides reference information only and does not constitute official legal, medical, or financial billing advice. Always consult the payer's official remittance advice and current coding guidelines.