Denial Codes - Healthcare

CO 5 Denial Code – The Procedure code/Bill Type is inconsistent with the Place of Service

Channagangaiah

Insurances Company will be denying the claim with CO 5 Denial Code – Procedure code/Bill Type is inconsistent with the Place of Service, whenever the CPT code is not compatible with the place the health care service provided to patient.

Now let us understand the below terms to understand the CO 5 Denial Code – The Procedure code/Bill Type is inconsistent with the Place of Service.

Procedure Code: Procedure code is a 5 character code (numeric or alpha numeric) used to describe the healthcare services/treatment provided by the healthcare provider/ hospital. Procedure Code indicated on HCFA 1500 in field location 24D.

Bill Type: Bill Type is a 3 digit code, which describes the type of bill a provider is submitting to insurance. Bill Type is used on UB 04 claims in field locator 4.

Place of Service: Place of Service is also called as POS and it is a 2 digit code, which designates where the actual health care services rendered to patient (Examples: Home, Hospital, office, clinic, etc.) Place of Service indicated on HCFA 1500 in field location 24B.

What action AR team(Provider) needs to take to resolve CO 5 denial code – The Procedure code/Bill Type is inconsistent with the Place of Service?
  • When they get CO 5 denial code, first review other date of service for this patient to determine if same Procedure code/ Bill type/Place of service were paid previously. If they have paid the previous claims with same procedure code/bill type/place of service, then call the insurance company claims and reprocess the claim with rep by referencing the previous paid claim for same patient and provider.
  • If no previous date of service were paid, send the claim to coding team to review the correctness of Procedure code/Bill type/Place of service. If coding team finds the claim billed is correct, call the insurance to reprocess the claim. If the representative refuses to send the claim back for reprocess, submit an appeal along with medical reports.
  • If coding team suggest alternative codes, update the correct codes and resubmit the claim as corrected claim.
  • If previous notes states appeal is already sent, then call the insurance for appeal status.
Call insurance company claims department and ask below details for CO 5 Denial Code – Procedure code/Bill Type is inconsistent with the Place of Service:
  • Whenever you call claims department, always collect claim received and denial date from the representative?
  • Next step is to verify with the rep, correct place of service for the procedure code billed or for the bill type reported. (If the procedure billed is incorrect then forward the claim to coding team to correct the claim and resubmit the claim as corrected claim).
  • Get the corrected claim mailing address or fax number?
  • If suppose submitted claim is correct and rep refuses to reprocess the claim, then you have rights to appeal the claim with supporting documents for reimbursement. Collect the address for appealing the claim/fax number for appealing and time frame required to appeal the claim?
  • Finally get the claim number for reference.