Insurance will deny with CO 4 Denial Code – The procedure code is inconsistent with the modifier used or a required modifier is missing, whenever the CPT code billed with an incorrect modifier or the necessary modifier is absent in the submitted claim.
Let us see below examples to understand the above denial code:
Example 1:
Assume provider has performed the electrical stimulation procedure (invasive) to aid bone healing for patient name John.
In this example we have to report the claim with the procedure code 20975. If suppose provider submits this procedure code along with modifier 51, then claim will be denied as CO 4 Denial Code – The procedure code is inconsistent with the modifier used or a required modifier is missing. Because as per CPT book guidelines for procedure code 20975 modifier 51 is exempted, so we should not report procedure code 20975 with modifier 51.
Example 2:
Bone graft codes are reported with (through CPT 20900 to CPT 20938).
As per the guidelines for bone graft codes, we should not report with modifier 62 (two surgeons). If we report then claim with modifier 62 for bone graft codes, then claim will be denied as CO 4 denial code.
Note: Similarly some procedures need to be reported with modifier, those claims will be denied with the same denial code if it’s not reported. So coding team need to be careful while coding some procedures along with modifiers.
Let us see first what is Modifier in medical billing.
Modifier:
Modifier is a 2 digit code added to the procedure code, if there is any alteration/specification of the treatment/services rendered to the patient.
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