CO236 denial code description and corrective action

• For the use of modifiers, we must keep in mind their proper combination with the CPT code. If a modifier is not appropriate or does not align with the procedure code, the claim may be denied with this denial code.

• This denial is related to coding.

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 and call reference number, and then follow up on the claim after the provided TAT.

• Consult coding specialists to review the coding and determine if there is any alternate modifier or procedure that can be used.

• We can also use websites to check NCCI edits.

• If the coding team confirms that the coding is correct, 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 coding).

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

• 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.

Description