Denial Codes - Healthcare

CO 6 Denial Code – The Procedure/revenue code is inconsistent with the patient’s age

Channagangaiah

When the claim says CO 6 Denial Code – The Procedure/revenue code is inconsistent with the patient’s age, it means claim denied as the CPT code or revenue code billed is not compatible with patient age.

Let us consider the below examples to understand CO 6 denial Code:

Example 1: John (aged 23) takes the preventive medicine E & M services from the healthcare provider on 01/15/2020 as a new patient visit.

The following sets of codes are used to report the new patient preventive medicines E & M services (99381-99387):

99381 Initial Comprehensive Preventive medicine ;( age younger than 1 year)

99382 (age 1-4 years)

99383 (age 5-11 years)

99384 (age 12-17 years)

99385 (age 18-39 years)

99386 (age 40-64 years)

99387 (age 65 years and older)

So here it’s clearly understood the focus of the preventive medicine services will depend on the patient’s age. In the above example John age is 23, hence we need to bill the claim with the procedure code 99385(age 18-39 years).

Suppose assume claim submitted with an incorrect procedure code 99386, in that case insurance will deny the claim with CO 6 denial Code. Because patient age is 23 and the procedure code billed is 99386(age 40-64 years). So the correct code 99385 should be reported in order to get rid of the denial code CO 6 and reimburse the claim.

Example 2: Physician performed a surgery by division(a repair of patent ductus arteriosus) for the patient Harris (aged 19 years) on 12/28/2019.

Similar to the above example this services hinge on patient’s age.

Surgery code 33822 is for below 18 years.

Surgery code 33824 is for 18 years and older.

In this example patient Harris age is 19 years and claim should be reported with surgery code 33824 for reimbursement.

If suppose claim submitted with 33822 then claim with be denied with denial code CO-6 The Procedure/revenue code is inconsistent with the patient’s age. So we should be very careful while coding this age banded procedure codes in medical billing.

What action AR team (Provider) needs to take to resolve CO 6 denial code – The Procedure/revenue code is inconsistent with the patient’s age?
  • Review the application to get the correct Date of Birth of the patient to determine the correct age.
  • Next step is to send the claim to coding team to review the correctness of Procedure code/revenue code. If it is correct, call the insurance company to reprocess the claim. If rep refuses to send the claim back for reprocessing, then you have rights to appeal the claim with medical records/supporting documents.
  • If coding team suggests the correct procedure/revenue code, then update the correct procedure code/revenue code and submit the claim marking as corrected claim in block 19.
Call the insurance company claims department and ask below details for CO 6 Denial Code-The Procedure/revenue code is inconsistent with the patient’s age:
  • At any time if claim denied first ask and collect received date and denial date of the claim with representative.
  • Next step is to check, which procedure/revenue code is inconsistent with patient’s age and take necessary action (Forward to coding team for correctness)
  • If everything seems to be correct then get the appeal address or appeal fax# and Limit for appealing the denied claim.