CO 11 The diagnosis is inconsistent with the procedure.
Solution:
This denial indicates the procedure code billed is incompatible with the diagnosis.
• Before billing a claim, you may access the Procedure to Diagnosis look up/ Services Indication Report to determine if the procedure code to be billed is payable under the specific diagnosis.
• You may also refer to “ Local Coverage Determinations” for a list of procedure codes, relating to the services addressed in the LCD, and the diagnoses for which a service is/is not considered medically reasonable and necessary.
Tips to correct the denied claim :
If a payable diagnosis is indicated in the patient's encounter/service notes or record, correct the diagnosis and resubmit the claim.
• Do not resubmit an entire claim when partial payment is made; correct andresubmit denied lines only.
Tags:
CPT / DX denial