Last Modified: 2/1/2018 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the Current Procedural Terminology® (CPT®) or Healthcare Common Procedure Coding System (HCPCS) code/was invalid or outdated for the date(s) of service (DOS) on the claim.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 by The Centers for Medicare & Medicaid Services (CMS) on a quarterly basis (January, April, July and October). Review HCPCS quarterly updates at CMS Healthcare Common Procedure Coding System (HCPCS) Quarterly update website .
• Verify procedure code is valid, allowed and payable by Medicare for the date(s) of service on your claim via the Medicare physician fee schedule lookup tool, 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 invalid 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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