diagnosis inconsistent denial - CO 11

CO 11  The diagnosis is inconsistent with the procedure. 

 Solution:

This denial indicates the procedure code billed is incompatible with the diagnosis.

• Before billing a claim, you may access the Procedure to Diagnosis look up/ Services Indication Report  to determine if the procedure code to be billed is payable under the specific diagnosis. 

• You may also refer to “ Local Coverage Determinations” for a list of procedure codes, relating to the services addressed in the LCD, and the diagnoses for which a service is/is not considered medically reasonable and necessary.

Tips to correct the denied claim :

If a payable diagnosis is indicated in the patient's encounter/service notes or record, correct the diagnosis and resubmit the claim.

• Do not resubmit an entire claim when partial payment is made; correct andresubmit denied lines only.

Posted in: CPT / DX denial