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.
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.
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