Denial Code CO 47: Diagnosis Missing or Invalid
Insurances Company will be denying the claim with CO 47 Denial Code: This (these) diagnosis (es) is (are) not covered, missing, or are invalid, whenever the Diagnosis CPT code is not Valid or missing.
Diagnosis Code is Invalid
The payer is indicating that one or more of the diagnosis codes you have entered is not valid. This could mean that it is not from the data set of diagnosis codes (ICD) or it could mean that a diagnosis code you supplied is not accepted by this payer.
How to Fix
The diagnosis codes are entered / edited from the add / edit client form, in the section labeled Cases. Open up the edit client form for this page. At the bottom right, click the edit icon associated with the diagnosis code set. Remove the offending diagnosis code. Remember to save the client when done.
CPT Codes / Modifiers / Diagnosis Codes
Some insurance payers will reject a claim if an unauthorized CPT code or modifier combination is used, based on their claim filing guidelines. These guidelines are established by each insurance payer individually, so you’ll want to follow up with the payer directly to check that the codes included on the claim form are within their restrictions.
Once you’ve determined the rejection reason, you can:
- Update the appropriate setting in your Simple Practice account to ensure that the correct information populates going forward
- Download a copy of the original claim
- For instructions on how to store a downloaded claim, see: How do I store client documents?
- Make note of both the Clearinghouse Reference Number, and the Payer Claim Number if it’s available
- This will ensure both are easily accessible in case there’s an issue with timely filing
- Delete the previously rejected claim and recreate it
How to Assign Medical Diagnosis and Procedure Codes
the Medical Coder must identify the illness or disease and find the corresponding diagnosis code in the International Classification of Diseases (ICD) book, Volumes 1 and 2. (The current edition is ICD-9, but it will soon be ICD-10.) This book is the bible of coding, containing all the diagnosis codes.
After finding the diagnosis codes, you then look up the procedure codes that best describe the work done, using one of the following books:
- The Current Procedural Terminology (CPT) book: The CPT book contains all the procedure codes as determined by the American Medical Association (AMA) and includes the definition of each procedure. Physicians and outpatient facilities choose a code from the CPT book.
- The ICD-9 Volume 3 book:Hospital inpatient procedures are chosen from the ICD-9 Volume 3 book.
But they each must be separately billable or have involved extra work by the surgeon in order to justify unbundling them (or billing them separately). Coding can get pretty complicated. Keep this in mind: Coding a procedure is simple if you remember to break it down into small bites.
Physician coding is just what it sounds like: coding diagnoses and procedures representing the work performed by a physician. Under certain circumstances, work performed in an outpatient setting, such as an ambulatory surgery center (ASC), also uses physician coding.
Physician offices, ambulatory surgery centers, and other outpatient facilities use the CPT code sets to represent the procedure performed. Physician claims are submitted on the HCFA/CMS-1500 claim form. In most circumstances, facilities bill commercial carriers on the UB-04 claim form.
Coding for facility reimbursement often pertains to hospital coding. Specific coding and billing guidelines exist for hospital billing. If you are working as a facility coder in a hospital, you use Volume 3 of the ICD-9 book to identify the procedures.
Denial & Rejection CO 8: Due to Taxonomy Code
Denial Reason CO-50: Non-Covered Services Medical Necessity