Wednesday, December 21, 2011

Inappropriate or invalid place of service - Action on Denial

CO 58 - Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service


(PLACE OF SERVICE CONFLICTS WITH PROCEDURE CODE. SUBMIT NEW CLAIM)



Resources/tips for avoiding this denial

Denial indicates the procedure code billed is incompatible with the place of service (POS) code.

• Before billing a claim, refer to billing guidelines for the procedure or service being performed.

• The Current Procedural Terminology (CPT) code definition may indicate the place of service. Refer to the current year’s CPT manual for this information.

• Example: A code described as an outpatient service would not be valid if billed with an inpatient POS.



• Respond promptly to a request for additional documentation (ADR). Failure to respond to an ADR will result in claim denials.


Tips to correct the denied claim

Correct the place of service (POS) code or CPT code and resubmit the corrected claim

1 comment:

  1. If we have a denial for CO58 and can not get paid for the global service-is it correct to then bill for the subsequent care visits since we did not receive payment for the Surgery?

    ReplyDelete

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