Denial & Rejection CO 8: Due to Taxonomy Code

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Denial & Rejection CO 8: Due to Taxonomy Code

 

Denial Code CO 8: The procedure code is inconsistent with the provider type/specialty (taxonomy)

This needs to go to whomever in your system set up the billing system. They need to check the provider taxonomy codes to see if that provider is correctly set up for the type of service that was being done. Every provider has a number of taxonomy codes to choose from for the types of service they perform. If the correct one is not registered, payment will be denied for certain types of care.

What is a Taxonomy?

In a broad sense the science of classification, but more strictly the classification of living and extinct organisms—i.e., biological classification. The term is derived from the Greek taxis (“arrangement”) and nomos (“law”). Taxonomy is, therefore, the methodology and principles of systematic botany and zoology and sets up arrangements of the kinds of plants and animals in hierarchies of superior and subordinate groups. Among biologists the Linnaean system of binomial nomenclature, created by Swedish naturalist Carolus Linnaeus in the 1750s, is internationally accepted.

Popularly, classifications of living organisms arise according to need and are often superficial. Anglo-Saxon terms such as worm and fish have been used to refer, respectively, to any creeping thing—snake, earthworm, intestinal parasite, or dragon—and to any swimming or aquatic thing. Although the term fish is common to the names shellfishcrayfish, and starfish, there are more anatomical differences between a shellfish and a starfish than there are between a bony fish and a man. Vernacular names vary widely. The American robin (Turdus migratorius), for example, is not the English robin (Erithacus rubecula), and the mountain ash (Sorbus) has only a superficial resemblance to a true ash.

What is a taxonomy code?

Taxonomy Codes are an administrative code set for identifying the provider type and area of specialization for healthcare providers. They are alphanumeric and are ten characters in length. Taxonomy codes allow providers to identify their specialty. A provider can have more than one taxonomy code. When a provider applies for an NPI number, he or she must select at least one taxonomy code indicating their specialty.

On Call Scenario:

  1. Claim denied as the procedure code is inconsistent with provider type/specialty
  2. May I get the denial date?
  3. What is the exact reason for denial?
  4. Provider specialty is not allowed to perform this service
  • Check the provider specialty on NPPES Website (Just enter rendering provider’s NPI  in NPI Number section and click on ‘Search’ Button. you will get provider  specialty under ‘Primary Taxonomy Section)
  • Verify specialty with CPT
  • IF Different (May I have the claim# & Call Ref#)
  • IF Same (Ask rep to send claim for reprocessing)
  1. At which box# on claim form taxonomy code is missing? IF No: May I have the claim# & Call Ref#
  • Check the claim form if taxonomy code is available or not
  • IF Yes (Ask for clarification from rep and send claim back for reprocessing)
  • Rep agrees, IF Yes:  What is the TAT for reprocessing? IF No: May I have the claim# & Call Ref#

Important Note:

  • In CMS 1500 form, rendering provider’s taxonomy code is available on box# 24J above NPI and billing provider’s taxonomy code is available on box# 33b.
  • When taxonomy code is available in CMS 1500 and rep still not able to find from their end then resubmit the claim again, information may be missing due to some error.
  • When taxonomy code is not available on claim form then resubmit the claim to check taxonomy code still going on claim form or not. If it is still missing then inform the same to client.

What are the Healthcare Provider Taxonomy Codes (HPTC)?

Where may I obtain a copy of the codes? The Healthcare Provider Taxonomy Codes (HPTC) are a HIPAA standard code set named in the implementation specifications for some of the ASC X12 standard HIPAA transactions. The “Healthcare Provider Taxonomy Code” is a situational data element in the 4010 X12 Implementation Guides and the 5010 X12 TR3 Reports for the 837 Professional and Institutional. If the Taxonomy code is required in order to properly pay or process a claim/encounter information transaction, it is required to be reported. Thus, reporting of the Healthcare Provider Taxonomy Code varies from one health plan to another. The Healthcare Provider Taxonomy code set divides health care providers into hierarchical groupings by type, classification, and specialization, and assigns a code to each grouping. The Taxonomy consists of two parts: individuals (e.g., physicians) and non-individuals (e.g., ambulatory health care facilities). All codes are alphanumeric and are 10 positions in length. These codes are not “assigned” to health care providers; rather, health care providers select the taxonomy code(s) that most closely represents their education, license, or certification. If a health care provider has more than one taxonomy code associated with it, a health plan may prefer that the health care provider use one over another when submitting claims for certain services.

Learn More…

CPT Category Codes by Specialty 2021

Four Ways Providers Can Prevent Denials & Work More Seamlessly with Payers

Nerve Conduction Studies and Electromyography Coding Tips

 

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