DENIAL CODE CO-9: The diagnosis code is inconsistent with the patient’s age
Insurance will deny the claim with CO-9 denial code – The diagnosis code is inconsistent with the patient’s age, when the diagnosis code is not compatible with the patient’s age.
Let us consider the below examples to understand CO-9 denial Code:
Scenario 1:
Let us assume Mike (41 year old) has done is BMI.
Body Mass Index (BMI) ICD 10 diagnosis codes Z68 series and they are coded correctly based on the patient’s age.
They have expanded Z68 series diagnosis codes into adult and pediatric BMI categories and this will be coded, based on patient’s age.
Answer: ICD 10 diagnosis code is Z68.41 (Body Mass Index 40.0-44.9 adult).
Suppose if they have coded the claim with Z68.45 diagnosis code (Body Mass Index 70 or greater adult), claim will be denied with CO-9 Denial Code – The diagnosis code is inconsistent with the patient’s age. Because patient’s age is 41 and the diagnosis code Z68.45 is for age 70 or greater adult. Correct diagnosis code Z68.41.
Scenario 2:
Let us assume health examinations done for newborn baby (26 days old).
Encounter for newborn, infant and child health examinations, Z00 series diagnosis code coded correctly based on child’s age.
Answer: ICD 10 diagnosis code – Z00.111 (Health exam for newborn, under 8-28 days old).
Suppose if they have coded the claim with Z00.110 diagnosis code (Health exam for newborn, under 8 days old), claim will be denied with CO-9 Denial Code – The diagnosis code is inconsistent with the patient’s age.
Call the insurance company claims department and ask below details for denial code CO-9:
- Get receive and denial date of the claim.
- verify which diagnosis code is inconsistent with patient’s age
- Check with coding team for correct diagnosis code which is consistent with patient’s age or Patient’s gender. (If the coding team suggests correct diagnosis code, then update and resubmit the claim as corrected claim).
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