C234 denial code description and corrective action

This procedure is not paid separately.

There are certain procedures that cannot be billed alone and require a primary procedure code for reimbursement. If the procedure is billed without the primary procedure, or if the wrong primary procedure is used, this denial is received.

First, we need to verify the status of the claim. This can be done by checking the status through the insurance web portal or by calling the payer.
Call the insurance company to obtain information about the primary procedure code. If it is found that we already billed the procedure along with the primary procedure code, or if there is a paid claim in the member’s history with the same coding, then ask the representative to reprocess the claim. Be sure to note the representative’s name, claim number, and call reference number, and follow up on the claim after the provided TAT.
If the representative does not provide the primary procedure code, then contact the coding team to review the coding.
If the coding team provides the correct primary procedure code and it is not present in the system, then resubmit the claim with both procedures.
If the coding team confirms that the coding is correct and the procedure can be billed alone, but the representative still refuses to reprocess the claim, then we proceed with submitting an appeal.
For submitting an appeal/corrective claim, we must calculate the timely filing limit starting from the processed date. If the limit has been exceeded, the claim will be denied again for exceeding the filing deadline. In such cases, we should consult with the provider. Some clients may still want us to submit the appeal/corrective claim even after the timely filing limit has passed, so we should proceed according to their instructions.