When the claim states CO 6 Denial Code – The Procedure/revenue code is incompatible with the patient’s age, the claim was denied because the CPT code or revenue code billed is inconsistent with the patient’s age.
Consider the following samples to understand CO 6 denial Code better:
Example 1: John (age 23) visits the healthcare provider for preventive medicine E & M services as a new patient on 01/15/2020.
The following sets of codes are used to record new patient preventative medications E & M services (99381-99387)
Starting Comprehensive Preventive Medicine;
- 99381 (age younger than one year)
- 99382 (age 1-4 years)
- 99383 (age 5-11 years)
- 99384 (age 12-17 years)
- 99385 (age 18-39 years)
- 99386 (age 40-64 years)
- 99387 (age 65 years and older)
As a result, the patient’s age will determine the focus of preventive medicine services. In the above example, John’s age is 23, and we must bill the claim with the process code 99385. (age 18-39 years).
Assume a claim is filed with the wrong procedure code 99386; in this situation, insurance will deny the claim with the CO 6 denial code. Because the patient is 23 years old and the operation code billed is 99386 (age 40-64 years).
As a result, the proper code 99385 must be reported to remove the denial code CO 6 and reimburse the claim.
Example 2: A physician did a surgery by division (a correction of patent ductus arteriosus) for the patient Jessica (aged 29 years) on 01/15/2020.
Like the last example, this service is dependent on the patient’s age.
Surgery code 33822 is for patients under the age of 18.
Surgery code 33824 is for those over the age of 18.
In this case, the patient’s age is 29 years, and the claim should be submitted with surgical code 33824 for reimbursement.
If a claim is filed with code 33822, it will be rejected with the denial code CO-6. The procedure/revenue code does not match the patient’s age. As a result, we must be cautious when classifying these age banded procedure codes in medical billing.
What steps must be taken to resolve denial code CO 6?
- Examine the application to obtain the patient’s proper Date of Birth to calculate the correct age.
- The claim will then be sent to the coding team to review the process code/revenue code accuracy. Contact the insurance company to have the claim reprocessed if it is correct. If the representative refuses to send the share back for reprocessing, you have the opportunity to file an appeal with medical records/supporting papers.
- If the coding team offers the proper procedure/revenue code, modify the appropriate procedure/revenue code and file the claim in block 19 as a corrected claim.
Call the insurance company’s claims department and request the following information for denial code CO 6:
If a claim is refused, the representative should first inquire and gather the claim’s receipt date and rejection date.
The next step is to determine which procedure/revenue code is incompatible with the patient’s age and take appropriate action.
If everything appears to be in order, obtain the appeal address or appeal fax number and the time limit for appealing the refused claim.
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