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Medicare - CO151 - Payment adjusted because the payer deems the information
aiken2017:
Hi, I am having a similar problem with Medicaid as primary cpt code 99213 and denial CO151 no remarks. this is the first visit in over an year. I look at the units and is just 1 unit so definitely is not an unit issue. does anybody knows what could be the problem? for some reason with Medicaid I get a lot of denials that do not happen with other payers including Medicare. we are locate in South Carolina so I verified the LCD before asking and is not a problem either :(
Michele:
I'm not familiar with SC Medicaid but in NY they have a certain number of visits they can have in a year. If they go over that number the provider must complete a Threshhold override form to request additional visits. It sounds like it might be that.
aiken2017:
Thank you so much Michelle. They finally reach out to me. The problem was that we have the incorrect carrier code under the claims. So everything look like a completely different denial when in reality was something as simple as correcting the 3 digits carrier code. :) oh boy.
Michele:
That is unfortunately common to receive a denial that is completely different than the real reason.
PMRNC:
The advise by Sriram_Sub is NOT advice I would follow. I'm upset that other's have not broached this subject.
Do not ever take advice from a coder or entity that is based offshore.
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