Last Modified: 7/26/2018 Location: FL, PR, USVI Business: Part B
Return unprocessable claim (RUC) reason code CO 181 FAQ
Q: We received a RUC for claim adjustment reason code (CARC) CO 181. What steps can we take to avoid this RUC code?
Procedure code was invalid on the date of service.
A: You received this RUC because the Current Procedural Terminology® (CPT®) or Healthcare Common Procedure Coding System (HCPCS) code was invalid or not active for Medicare on the date(s) of service (DOS) on the claim. Note that while a CPT® or HCPCS code may currently be valid, it may not be valid for the DOS on your claim.
• CPT® codes are revised annually by the American Medical Association (AMA), with changes effective January 1. Ensure you are using the valid CPT® book for the DOS on your claim.
• HCPCS codes are updated quarterly (beginning in January) by The Centers for Medicare & Medicaid Services (CMS). Review quarterly updates at CMS Healthcare Common Procedure Coding System (HCPCS) Quarterly update website .
• Verify procedure code is valid/active and payable by Medicare for the date(s) of service on your claim via the Medicare physician fee schedule lookup, available on the First Coast provider website.
• Consider ABILITY | PC-ACE™ software, updated with the most current CPT® codes, to ensure claims are submitted with valid procedure codes. Click here for information on ABILITY | PC-ACE™ software, offered by First Coast.
• Submit separate claims for services in different years of service. A procedure code may be valid one year and not valid the following year.
To avoid delay in payment, submit a corrected claim with a valid CPT® or HCPCS code for the date(s) of service. Claims that are returned as unprocessable cannot be appealed, as an initial determination was not made. For more information, click here.
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Source: First Coast Education Action Team
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