How do I fix or resolve code 19?

Review the medical record to confirm whether the injury or illness is documented as work-related and whether the patient indicated a Workers' Compensation claim at the time of service. Obtain the Workers' Compensation carrier information, claim number, and adjuster contact from the patient or employer. Resubmit the claim to the Workers' Compensation carrier with the WC claim number, employer information, and all clinical documentation related to the work-related injury. If the injury is not work-related but the payer denied the claim based on incorrect information, file an appeal with documentation from the medical record showing the injury was not work-related and a patient statement confirming the circumstances. If the patient disputes the work-related designation, coordinate with the patient and employer to resolve the Workers' Compensation claim status before rebilling the health insurance plan.

19Denial CodeGeneral Adjustment

Code 19

Problem Description

This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.

Root Cause

The payer has determined that the injury or illness is work-related and therefore the liability falls under Workers' Compensation rather than the health insurance plan. When a patient presents with an injury that occurred at work or an illness caused by workplace conditions, the payer denies the medical claim and directs the provider to bill the Workers' Compensation carrier. This denial is based on the patient's history, the diagnosis (e.g., occupational injury codes S00-T88 with external cause codes Y92.0 for industrial setting), or information the payer has on file indicating a Workers' Compensation claim exists for this condition.

Resolution Steps

1Review the medical record to confirm whether the injury or illness is documented as work-related and whether the patient indicated a Workers' Compensation claim at the time of service.
2Obtain the Workers' Compensation carrier information, claim number, and adjuster contact from the patient or employer.
3Resubmit the claim to the Workers' Compensation carrier with the WC claim number, employer information, and all clinical documentation related to the work-related injury.
4If the injury is not work-related but the payer denied the claim based on incorrect information, file an appeal with documentation from the medical record showing the injury was not work-related and a patient statement confirming the circumstances.
5If the patient disputes the work-related designation, coordinate with the patient and employer to resolve the Workers' Compensation claim status before rebilling the health insurance plan.

EHR Documentation Note

Claim denied 19 — work-related injury/illness; verified work-related status in medical record, obtained WC carrier info, and resubmitted claim to Workers' Compensation.

Preventative Action

Document the cause of injury and work-relatedness at every visit for injury-related diagnoses and verify Workers' Compensation coverage before billing the health insurance plan.

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.