Denial Codes - Healthcare

CO 7 Denial Code – The Procedure/revenue code is inconsistent with the patient’s gender

Channagangaiah

When the claim denied as CO 7 Denial Code – The Procedure/revenue code is inconsistent with the patient’s gender means the CPT code or revenue code billed is not compatible with patient gender (Male/Female).

Consider the below example to understand when the insurance will deny the claim as CO 7 denial code:

Example 1:

Let us assume, female named Maria has undergone a surgery with Cystourethroscopy with internal urethrotomy.

In this case the following surgery codes are used to report the above procedures:

  • 52270 CPT code used for Female
  • 52275 CPT code used for Male

So here it’s clearly understood the focus of the above surgery code will depend on the patient’s gender (Male/Female). In the above example Maria is female and need to bill the claim with the surgery code 52270.

Suppose assume claim submitted with an incorrect surgery code 52275 which is for male, then the claim will be denied with CO 7 Denial Code – The Procedure/revenue code is inconsistent with the patient’s gender. Because patient gender is female and the surgery code billed indicates male (which is not compatible with patient’s gender).  For above example claim should be billed with CPT code 52270 in order to get rid of denial code CO 7.

Example 2:

Assume Male patient underwent excision of total Urethrectomy including cystotomy.

Here the excision codes are reported with the following surgery codes:

53210 procedures is for female

53215 procedures is for male

Even this is code is decided based on the patient’s gender (Male/Female). In this example patient is male and the correct to be reported to insurance company for reimbursing is 53215.

Suppose claim submitted with an incorrect procedure code 53210 which is for female, then insurance will deny the claim stating CO 7 Denial Code – The Procedure/revenue code is inconsistent with the patient’s gender. As we know 53210 procedure code is for female but the patient gender is male.

With the above two examples we come to the conclusion that we should be very careful while coding the claims in order to get rid of this type of denials in medical billing.

What action AR team (Provider) needs to take to resolve CO 7 denial code – The Procedure/revenue code is inconsistent with the patient’s gender?
  • Review the application to see the demographic entry team entered patient’s gender correctly.
  • Next step is to send the claim to coding team to review the correctness of Procedure code/revenue code which is compatible with patient’s gender. If billed procedure/revenue code is correct, call the claims department of insurance and reprocess the claim. If representative refuses to send the claim back for reprocessing, appeal the claim along with medical records.
  • If coding team suggests the correct procedure/revenue code which is compatible with patient’s gender, then update the code and submit the claim as corrected claim.
Call insurance company claims department and ask below details for CO 7 Denial Code:
  • Whenever claim denied, first get the received date and denial date of the claim?
  • Next step is to verify with rep, which procedure code or revenue code is inconsistent with patient’s gender?
  • Get the appeal address for appealing if required or fax# and then time frame for appealing the claim?
  • At last get the Claim number and Cal reference number?