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Denial code 151 occurs when the payer adjusts the claim because the payer deems the information submitted does not support this many/frequency of services as a result, the payment is adjusted or denied.
Common causes of code 151 are:
1. Payer guideline: Some payers have specific coverage limitations or guidelines regarding the frequency or number of services that will be reimbursed.
2. System is not updated: If you call the insurance, they state that the mentioned CPT can be reimbursed only twice a day, but system has no evidence that states it was reimbursed twice on that day as charges were not posted in system.
3. Insufficient documentation: If the submitted document does not justify the number of frequency of services billed like incomplete medical records, Progress notes. So, it states that this much frequency was not needed hence denial occurs.
4. Lack of pre-authorization: Some services may require pre-authorization and if provider does not obtain the prior approval before performing the service it can be denied.
5. Coding errors: If the services are not accurately coded due to which there is discrepancy in the submitted claim.
6. Coverage issue: If the patient’s insurance has the limitation of the coverage and benefits.
Ways to mitigate code 151 include:
1. Payer guideline: Always have the updated guidelines from the payor before submitting any claim to avoid future denial as some payers have specific guidelines regarding the frequency or number of services that need to be reimbursed.
2. System is not updated: Always update the system timely so utilize technology driven solutions.
3. Review the claim carefully to determine that all the necessary information has been submitted accurately and check the details like medical records, Progress notes if the services provided are medically necessary.
4. Some services require pre-authorization so while reviewing claim form if you find that authorisation number is not updated in claim form update it before submitting so billing team should be careful.
5. Ensure coding is correctly done and follow the standard payer’s coding guidelines. Look for any coding errors or discrepancies that may have resulted in the denial.
6.Follow up with the payer on time to take action like submission of corrected claim or an appeal, initiate the necessary steps promptly.
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