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Last Modified: 12/4/2010
Location: FL, PR, USVI
Business: Part B
CO 11
The diagnosis is inconsistent with the procedure
(THIS PROCEDURE/ITEM NOT PAYABLE FOR THE DX AS REPORTED (LMRP))
Resources/tips for avoiding this denial
This denial indicates the procedure code billed is incompatible with the diagnosis.
• Access the Procedure to Diagnosis Lookup/Service Indication Report 
before billing a claim to determine if the procedure code to be billed is payable under the specific diagnosis.
before billing a claim to determine if the procedure code to be billed is payable under the specific diagnosis. • Refer also to “Active/Future/Retired LCDs” for a list of procedure codes, relating to the services addressed in the local coverage determination (LCD), and diagnoses for which a service is/is not considered medically reasonable and necessary.
Resource available through the First Coast Service Options (FCSO) Medicare training website (www.fcsomedicaretraining.com) 
:
:• Recording of a FCSO webcast on April 22, 2009: Find LCDs and medical coverage information - Part A/B located in the "Library" of the FCSO Medicare training website , under "Online resources."
, under "Online resources."Tips to correct the denied claim
If a payable diagnosis is indicated in the patient's encounter/service notes or record, correct the diagnosis and resubmit the claim.
• Do not resubmit an entire claim when partial payment is made; correct and resubmit denied lines only.
Please use your browser's back button to return to the referring page.Source: FCSO Education Action Team
