CO-152 denial code
The payer thinks the documentation doesn't support how long the service lasted.
“Payer deems the information submitted does not support this length of service.”
Start 10/31/2002 · Last modified 07/01/2017 · X12 adjustment reason code list
What it usually means in behavioral health
In residential, detox, and PHP, CO-152 usually means the payer approved fewer days than the stay lasted, or ended coverage at a review date while treatment continued.
It can also apply to session length on time-based codes, so check whether the denial is about days or minutes.
Common causes
- Stay continued past the last day the payer approved in concurrent review
- Discharge criteria in the payer's guideline judged as met before the actual discharge
- No clinical documentation for the days past the last review
- Session time documentation shorter than the billed code requires
Correct and resubmit, or appeal?
For length of stay, appeal the concurrent-review decision with day-by-day documentation of why discharge or step-down wasn't safe. For session length, correct the code if the time wasn't there, or appeal with the timed note if it was.
What to do
Identify the last approved day and the review decision that ended coverage.
Assemble documentation for each denied day: risk, response to treatment, and discharge barriers.
Appeal within the plan's deadline, and request the discharge criteria the reviewer applied.
Often seen with
- N130
Got a CO-152 on your desk?
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