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).
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:
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.
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