Denial Code CO 4 – The procedure code is inconsistent with the modifier used or a required modifier is missing

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:

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:

  1. First review and check to see with the coding team that the used modifier is in-consistent or required modifier is missing.
  2. Update the appropriate modifier and resubmit the claim (Some insurances, claims should be resubmitted as corrected claim).

Or

  1. 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.
  2. If they disagree then the final step is to appeal the claim with supporting documents.

You can reach the claims department with the following questions to resolve the below denial:

Denial Code CO 4 – The procedure code is inconsistent with the modifier used or a required modifier is missing
1May I know the Claim received date
2May I know the claim denied date
3May I know to which procedure code the modifier is Inappropriate or missing
4May I know the appropriate modifier for the procedure code billed
5If Representative provide the appropriate modifierIf they won’t provide
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 resubmittedCheck 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.

6May I know the claim#
7May I know the call ref#

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