How do I fix or resolve code 39?

Obtain the payer's authorization denial letter or portal notification to understand the specific reason the authorization was denied (medical necessity, non-covered benefit, or plan exclusion). Review the payer's coverage policy or medical necessity criteria for the denied service to identify what documentation or criteria were not met. If the service was not yet rendered, inform the patient of the authorization denial and discuss alternative treatment options or the option to proceed as a self-pay service with a signed financial responsibility form. If the service was already rendered, file a formal appeal with a detailed letter of medical necessity, the complete clinical documentation, and references to the payer's policy criteria that are met. If the appeal is denied, escalate to the second level of appeal (independent review organization for Medicare, external review for commercial) with peer-reviewed literature supporting the medical necessity of the service.

39Denial CodeGeneral Adjustment

Code 39

Problem Description

Services denied at the time authorization/pre-certification was requested.

Root Cause

The services were denied at the time authorization or pre-certification was requested. This means the payer reviewed the proposed service before it was rendered and determined it did not meet their coverage criteria — the denial occurred during the pre-service authorization process, not during post-service claim adjudication. The payer's clinical review team evaluated the request against medical necessity criteria, coverage policies, or plan benefits and denied the authorization before the service was performed. This is a pre-service denial, which means the provider had notice of non-coverage before rendering the service.

Resolution Steps

1Obtain the payer's authorization denial letter or portal notification to understand the specific reason the authorization was denied (medical necessity, non-covered benefit, or plan exclusion).
2Review the payer's coverage policy or medical necessity criteria for the denied service to identify what documentation or criteria were not met.
3If the service was not yet rendered, inform the patient of the authorization denial and discuss alternative treatment options or the option to proceed as a self-pay service with a signed financial responsibility form.
4If the service was already rendered, file a formal appeal with a detailed letter of medical necessity, the complete clinical documentation, and references to the payer's policy criteria that are met.
5If the appeal is denied, escalate to the second level of appeal (independent review organization for Medicare, external review for commercial) with peer-reviewed literature supporting the medical necessity of the service.

EHR Documentation Note

Claim denied 39 — services denied at authorization request; reviewed denial reason, filed appeal with medical necessity documentation, or informed patient of self-pay option.

Preventative Action

Implement a pre-authorization tracking system that flags denied authorizations before service delivery and obtain signed ABNs for services that proceed despite authorization denial.

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.