CO-7: The procedure/revenue code is inconsistent with the patient’s gender

Steps to resolve:

• Review the CPT billed based on the gender 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 gender is accurately recorded in the system.
• 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 gender-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 gender.

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