By recei CO- 6: The procedure or revenue code used for billing is not appropriate for the patient’s age.
This denial occurs as the procedure or revenue code used for billing is not appropriate for the patient’s age. As there are few CPTs defined which are based on the age of the patient.
Steps to resolve:
- Review the CPT billed as there are few CPTs defined which are based on the age of the patient. We can always call to insurance company and ask rep to send the claim back for reprocessing if claim was processed incorrectly.
- Ensure that the patient’s age is accurately recorded in the system and always check what was the age of the patient on date of service.
- After reviewing, we can send the claim to coding team to review the claim, and they can make the changes. 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.
- Contact payer to clarify any age-related coding requirements or policies. Always route the claim to coding team only after correctly mentioning all the details obtained from payer.
- Check the patient’s medical records to ensure that the procedure or revenue code aligns with the documented age.
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