CO182 denial code description and corrective action

• This denial occurs when the insurance considers the modifier used was invalid for date of service (DOS) reported.

Actions

• 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.

• The most important step is to determine whether the claim denial is valid or if the insurance has denied the claim by mistake.

• Call the insurance company, if claims in the member’s history with the same coding have been paid, and ask the representative to reprocess the claim. Be sure to note the claim number, rep name and call reference number, and then follow up on the claim after the provided TAT.

• Consult coding specialists to determine whether the modifier is appropriate or not.

• If the coding team confirms that the modifier is appropriate then we proceed with submitting an appeal.

• If we determine that the denial is accurate, then we submit a corrected claim with the required modifications (correct modifier).

• Sometimes, when the same procedure is billed on two separate lines with LT and RT modifiers, the insurance pays for one line but denies the other with this code. In such cases, a corrected claim should be submitted by billing the procedure with a 50 modifier on a single line, doubling the charge amount, and removing the second line.

• Medicare does not accept corrected claims, so in the case of any denial, a new claim must always be submitted.

• For submitting an appeal/corrected claim, 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/corrected claim even after the timely filing limit has passed, so we should proceed according to their instructions.

Description