What is the meaning of the CMS Medicare Claim Denial Reason
Code?: CO-16, CO/16, CO16 - Claim/service lacks information which
is needed for adjudication
Your Action and How to Avoid this Kind of Denial:
This kind of rejection is very straightforward and is also easy to fix. You can
get additional information about its denial by calling your local carrier's IVR
(Interruptive Voice Response)
What to do:
1. Check Box number 32, 33 and 24J on the HCFA 1500 form -- are the
information correct?
2. Check if you the procedure code needs a modifier
3. Check if your diagnosis code requires a 4th or 5th digit
4. Check if a referring physician on box 16 is required (don't forget its NPI!)
Useful References: CPT Code Books, CMS Website (www.cms.gov),
CCI Quarterly Updates, CPT Assistant Publications, Diagnosis Code
Books
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