Last Modified: 12/29/2017 Location: FL, PR, USVI Business: Part B
Denial reason code CO236 FAQ
Q: We are receiving a denial with claim adjustment reason code (CARC) CO236. What steps can we take to avoid this denial code?
This procedure or procedure/modifier combination is not compatible with another procedure or procedure /modifier combination provided on the same day according to the National Correct Coding Initiative.
A: You are receiving this reason code when the service(s) has/have already been paid as part of another service billed for the same date of service.
The basic principles for the correct coding policy are:
• The service represents the standard of care in accomplishing the overall procedure;
• The service is necessary to successfully accomplish the comprehensive procedure. Failure to perform the service may compromise the success of the procedure; and
• The service does not represent a separately identifiable procedure unrelated to the comprehensive procedure planned.
Please stay up to date with quarterly updates to the National Correct Coding Initiative (NCCI) edits
• The purpose of NCCI edits is to ensure the most comprehensive codes, rather than component codes, are billed.
• For assistance, review the National Correct Coding Initiative (NCCI) tutorial – code pair denials – this tutorial will demonstrate how to determine if a code pair will be denied due to NCCI.
• See the Centers for Medicare & Medicaid Services (CMS) internet-only manual (IOM), publication 100-04, chapter 12, section 30 for additional details on correct coding.
The following course is offered through First Coast University. After signing in, you will be automatically directed to the course. If you have an existing training account through First Coast University and wish to register for a specific online course, click the link to begin the registration process.
• National Correct Coding Initiative -- This intermediate level course will explore the methodology associated with correct coding and explain the NCCI Edit, development, and review processes.
• Click here for instructions on registering for a First Coast University training account if you do not have one.
If a modifier is applicable to the claim, apply the appropriate modifier and resubmit the claim. Be sure to submit only the corrected line. Resubmitting an entire claim will cause a duplicate claim denial.
• Refer to the Modifier FAQs for additional information.
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Source: First Coast Education Action Team
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