Insurance will deny the claim as Denial Code CO 4 – The procedure code is inconsistent with the modifier used or a required modifier is missing, whenever the procedure code billed with an inappropriate modifier or the required modifier is missing.
Modifier is a 2 character alpha numeric or numeric code that are used with CPT codes to indicate that a performed service has been altered by some specific circumstance but has not changed in its definition or code.
Please take the below action, when you receive the Denial Code CO 4 – The procedure code is inconsistent with the modifier used or a required modifier is missing:
- First review and check to see with the coding team that the used modifier is in-consistent or required modifier is missing.
- Update the appropriate modifier and resubmit the claim (Some insurances, claims should be resubmitted as corrected claim).
- If you find the claim submitted with an appropriate modifier, but the insurance denied the claim incorrectly. Then the next step is to reach claims department and send the claim back for reprocessing.
- If they disagree then the final step is to appeal the claim with supporting documents.
Once your claim has been rejected and it bears the CO 4 Denial code, there are two options that you are left with:
- Check if the modifier is in the consistent mode. If that is not the case, get in touch with the coding team and ask them to recheck and assign the right code.
Once that has been done you can move forth and resubmit your claims very easily. However, do remember to do that before the date expires for resubmission of claims.
- In case you see that the code is correct and no other changes need to be made, call to insuarnce company and ask them to reprocess the claim as denied in error.
In most cases, there will be a way to get the claim back.
Try to be extra cautious whenever you are filing your claim. Rejection due to simple mistakes makes the process more lengthy and tedious.
You can reach the claims department with the following questions to resolve the below denial:
- May I know the Claim received date?
- May I know the claim denied date?
- May I know to which procedure code the modifier is Inappropriate or missing?
- May I know the appropriate modifier for the procedure code billed?
If Representative provide the appropriate modifier
Call telephonic re-opening line update the modifier and send the claim back for reprocess(Medicare) or else for few insurances corrected claim should be resubmitted
If they won’t provide
Check with coding team and resubmit the claim with appropriate modifier or missing modifier.
If Coding team states already submitted modifier is appropriate and claim denied incorrectly, then you may appeal the claim with supporting documents.
So try to collect the appealing address and time limit or fax# to appeal the claim.
- May I know the claim Number?
- May I know the call ref Number?
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