Question Injectafer billing

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4
Location
Mclean, VA
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I am new as a coder & biller. I received a denial from magellan complete care with denial code CO_16. Can anybody help me to resolve this & guide me for the same. Which suitable modifier i can use or NDC billing unit for Inj. Injectafer IV with/without outpatient E/M service given. How to bill on Inj. Injectafer IV 750mg as an outpatient billing & coding. Please let me know.
Any other thing which i can skip, guide me on this.
Appreciate your inputs!!
 

trarut

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Columbus, OH
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CO-16 just means there is an error in the information submitted.

CO-16 Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

There should be remark codes reported with the CO-16 that will provide additional guidance as to what the true error is and what needs fixed. (Ideally, your payment poster should have posted the remark codes along with the claim adjustment code if your system allows it.) You really need to see the full copy of the original explanation of benefits or to call the insurance company for more information about the denial. You're just taking a shot in the dark to guess at this point. For example, Anthem BCBS regularly denies using a CO-16 when they want medical records for the claim. Once you know more about why the claim denied, you'll get better help from the users on the forum.
 
Messages
4
Location
Mclean, VA
Best answers
0
CO-16 just means there is an error in the information submitted.

CO-16 Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

There should be remark codes reported with the CO-16 that will provide additional guidance as to what the true error is and what needs fixed. (Ideally, your payment poster should have posted the remark codes along with the claim adjustment code if your system allows it.) You really need to see the full copy of the original explanation of benefits or to call the insurance company for more information about the denial. You're just taking a shot in the dark to guess at this point. For example, Anthem BCBS regularly denies using a CO-16 when they want medical records for the claim. Once you know more about why the claim denied, you'll get better help from the users on the forum.
Thanks for your help.
I need one more favour..... Which modifier can i use for IV infusion injectafer service given in office outpatient setup
 

trarut

True Blue
Messages
689
Location
Columbus, OH
Best answers
0
Thanks for your help.
I need one more favour..... Which modifier can i use for IV infusion injectafer service given in office outpatient setup
Do you mean for an office visit + injection? If - IF - you have a separately identifiable E/M service on that day, you can use a -25 modifier on the E/M code.
If you mean another scenario, you'll have to be more specific. Injectafer does not typically require any kind of modifier in the office setting.
 
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