By recei CO-4: The procedure code inconsistent with the modifier used or a required modifier is missing
Insurance denies the claim with CO 4 Denial Code – If the procedure code is inconsistent with the modifier used or a required modifier is missing, whenever the CPT code billed with an incorrect modifier, or the necessary modifier is absent in the submitted claim.
Steps to resolve:
- Review other date of service for the patient and check if same CPT codes were paid previously with the modifier in the claim or without the modifier. If claim was paid previously with the same situation mentioned in claim form, we can always call to insurance company and ask rep to send the claim back for reprocessing.
- After reviewing, we can send the claim to coding team to review the claim, and they can attach correct Modifier. Claim can be submitted again as corrected claim if any changes made by coding team.
- If insurance rep refuses to pay, there is always option to submit an appeal with medical records.
- Remember Medicare does not accept the corrected claim, so first send the void claim to the insurance then send a new claim with the changes made
- Always have the updated data of the insurance to file appeal.
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