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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