Code CO-181
Problem Description
Procedure code was invalid on the date of service.
Actionable Fix — Solution Steps
Refer to CPT Code Set and P-Auth File: -Verify claimed units, unit cannot be zero -Verify the service code reported is for the correct program, guarantor (Medi-Cal or County of Santa Clara) -Verify the effective date for the P-AUTH (FY of P-AUTH should be effective for DOS billed) -Verify the service rendered is covered under the P-AUTH being reported -If billed amount for service is zero, this is a valid denial
Related Codes in Contractual Obligation
The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)
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.