CO-236 denial code
A National Correct Coding Initiative edit says these two codes, or code and modifier combinations, don't go together on the same day.
“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 or workers compensation state regulations/ fee schedule requirements.”
Start 01/30/2011 · Last modified 07/01/2013 · X12 adjustment reason code list
What it usually means in behavioral health
The classic behavioral health example: CMS's NCCI policy manual says psychiatric diagnostic evaluation (90791, 90792) is not separately reportable with psychotherapy codes on the same date of service.
Other edits pair E/M and psychotherapy codes. The add-on codes exist precisely so both can be reported correctly.
Common causes
- Diagnostic evaluation and psychotherapy billed by the same practitioner on the same date
- E/M and standalone psychotherapy billed the same day instead of E/M with a psychotherapy add-on
- A modifier added to bypass an edit without documentation of a separate, distinct service
Correct and resubmit, or appeal?
If the combination isn't allowed, correct the claim to bill what the edit permits. Use a modifier only when the edit allows one and the record documents a separate, distinct service. Appeal only if the payer applied an edit that doesn't exist or allows a modifier you used correctly.
What to do
Check the NCCI edit for the code pair and its modifier indicator.
Rebill the correct combination, or use a modifier only with documentation to support it.
Train on the same-day rules for the codes your clinicians use most.
Often seen with
- N20
- M80
Got a CO-236 on your desk?
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