Denial Code CO 11

If CPT code submitted with an inappropriate diagnosis code, then insurance company will deny the claim with the denial code CO 11 – The diagnosis is inconsistent with the procedure code billed.

Denial Code CO 11 denial Solutions:

1. First step is to check the application and see whether the previous date of service with same CPT code and diagnosis code billed and received a payment. If we have received a payment for the same diagnosis and procedure code combination previously, then we need send the claim to reprocess by reaching out insurance claims department.
2. If we have not received a payment for previous date of service with combination of same procedure and diagnosis code, then we need to review the medical documents or we need to lend a help with coding team to check the used ICD code is really in-consistent with the procedure code billed and also check whether the claim billed as per Local-Coverage-Determination (LCD) guidelines.
3. If diagnosis code is inappropriate with the CPT code submitted, then update the appropriate DX code and resubmit the claim as corrected claim to insurance company.
4. If the DX code billed with CPT is appropriate as per medical records and billed as per LCD guidelines, but still insurance company denied the claim. In this case we need to reach out claims department and request the representative to send the claim back for reprocessing.
5. If representative disagree to send the claim back for reprocessing, then finally the last option is to appeal the claim along with medical and supporting documents.

Following Queries need to be inquired, when you reach out claims-representative:

• May I know the claim denied date?
• Could you please tell me which Dx code is inconsistent? (If there are multiple dx code billed)
• Upon checking the patient’s claim history, the previous DOS is paid with same CPT and dx code, could you please verify the same? (If previous date of service paid with same CPT and dx code).

(If claim-representative checked and found, then ask claim-representative to reprocess the claim)

• So, could you please send the denied claim back for reprocessing and what is the time frame to reprocessing the claim?

If even the previous Date-of-service denied, then get the corrected claim-mailing-address, and TFL to resubmit the corrected-claim

• May I know the corrected claim mailing address and time limit to resubmit the corrected claim?

Medical Billing Denials and actions – Top Denial codes Solutions (medicalbillingcycle.com)