Every denied claim can become a revenue loss if not addressed on time. Insurance companies use standard codes to explain why they reject your reimbursement requests. While some codes are irreversible, the good news is that you can resolve most of them with the right approach and actions.
As part of our series on simplifying and resolving different denial codes, today, our topic of discussion is one of the most frustrating denials – CO 236. Many practices and physicians experience this denial code when billing incompatible procedures together. But what does this mean, and how can you avoid this code the next time? Let’s explore all the details about the CO 236 denial code!
CO 236 Denial Code – Description
Are you confused by the vague description of the CO 236 denial code? Let us simplify it for you! The CO 236 denial code usually occurs due to unbundling. To be more precise, insurance companies flag your claim with this code when they find that a procedure or procedure/modifier combination is incompatible with another procedure or procedure/modifier combination performed on the same day.
Simply put, you receive this denial code 236 when a payer identifies issues with how you have billed the services together. We understand that you might be thinking, “Do payers randomly decide that your services are incompatible, or are there any specific standards?”
The answer is simple! Insurers decide based on the National Correct Coding Initiative (NCCI) edits, state-specific regulations, or fee schedules. In simple words? It means that, according to NCCI, you cannot bill separately for services that are part of a more comprehensive procedure.
Let us give you an example to clear up any confusion. A surgeon performs an ACL knee repair surgery (CPT code 29888) to restore the patient’s knee function. He administers anesthesia before the procedure to numb the area.
The surgeon bills for this surgery but makes the mistake of submitting a separate charge request for anesthesia. Since Medicare considers anesthesia a part of the original procedure, they deny this claim with a CO 236 denial code.
Common Causes of CO 236 Denial Code
Are continuous CO 236 denials leaving you frustrated? You can only move forward if you understand the common triggers of this denial code. Here are the top 5 reasons:
Unbundling
Unbundling is often the most common cause of receiving the denial code CO 236. As we said earlier, this denial code typically highlights an incompatible procedure or procedure/modifier combination with another procedure or modifier billed on the same day. This is common when services are unbundled inappropriately.
In simple terms, insurance companies deny your claim with this denial code 236 when you use separate codes to bill for services that are usually components of a main procedure.
NCCI Procedure-to-Procedure (PTP) Edits Violations
NCCI PTP edits clarify compatible and non-compatible procedure combinations to prevent unnecessary billing. Healthcare practices that violate these policies and bill mutually exclusive services face the CO 236 denial code.
Unusual Combination of Services
Insurance companies may also deny claims for billing unusual services together. These services are rarely performed in combination on the same day. Therefore, insurance companies can issue a CO 236 denial code if they determine these procedures as unnecessary or clinically inappropriate when performed together.
Lack of Modifiers or their Inappropriate Use
Some NCCI-associated modifiers, like 59, XE, XS, XP, and XU, can help you bypass NCCI PTP edits. However, their inappropriate use can result in greater problems. These codes help insurance companies identify separate, non-overlapping, or distinct services.
Most physicians and practices face denial code 236 because they attach modifiers on incorrect procedural codes or don’t use them at all.
Incomplete Documentation
Incomplete or missing documentation is another reason for receiving denial code CO 236. Insurance companies require justification for using NCCI-associated modifiers. Hence, practices, hospitals, or physicians who fail to provide the supporting documents for distinct and separately identifiable services deal with this denial code.
Non-Compliance with Regulations
State-specific workers’ compensation or fee schedules also outline rules for separately billable services. Those who fail to comply with their requirements face claim denials with the CO 236 denial code.
Denial Code 236 – Prevention Techniques
Want to avoid this frustrating denial code? Simply take the following precautions:
Understand NCCI PTP Edits
We understand how difficult it is to remember every incompatible coding pair. Therefore, the best way to comply with NCCI PTP edits is to use the lookup tool. Also, make sure to familiarize yourself with this program’s following Correct Coding Modifier Indicators (CCMI):
- 0: You cannot use NCCI PTP-associated modifiers
- 1: You can use NCCI PTP-associated modifiers under appropriate conditions
- 9: The use of NCCI PTP-associated modifiers is not specified
Use Comprehensive Codes
Instead of billing each procedure separately, identify whether they are part of a more comprehensive CPT code and use that to claim reimbursement for your services.
Use Appropriate Modifiers
If a service is distinct and separately identifiable, apply correct NCCI-associated modifiers to the appropriate CPT code. You can also use anatomical modifiers, such as RT and LT, to indicate surgeries performed on different body parts. However, avoid using these two-digit codes to bypass NCCI edits if they are clinically inappropriate.
Maintain Proper Documentation
Documentation can not only help you avoid the CO 236 denial code, but it can also save you from other denials. So, make it a habit to document everything. Your documentation should support the medical necessity of distinct services performed on the same day.
Stay Updated with Payer-Specific Guidelines
Another proactive approach is to stay updated with payer-specific guidelines, including CMS NCCI updates and fee schedules. You can do that by regularly visiting CMS’ website. This step will help you distinguish compatible procedure/modifier combinations from incompatible ones.
Also, note that some insurers may have their own rules for bundling and unbundling. Check their websites or contact them directly to clarify any confusion.
Conduct Several Checks Before Claim Submissions
Even with all the precautions, bundling and coding errors are quite common. You can avoid these mistakes by regularly reviewing your claims before submitting them to the appropriate payers. Use automated claim scrubbing tools to catch all potential coding mistakes and minimize the occurrence of denial code CO 236.
Train Your Billing Staff
You cannot do everything on your own. Therefore, to avoid future hiccups, regularly train your billing or coding staff on NCCI guidelines, including appropriate modifier usage and quarterly updates, to avoid billing for incompatible procedure combinations. This training will help your team identify bundled services.
Denial Code 236 – Resolution Strategies
Don’t know where to start from? Follow our step-by-step process to resolve the CO 236 denial code:
Check the Remittance Advice
As always, the first step is identifying the reason for claim denial. Check the Remittance Advice issued by the insurance company to confirm that you have received the denial code CO 236.
Review Procedure Codes
The next step is to review the procedural codes to check if you inappropriately unbundled some services or billed mutually exclusive services together. Use the NCCI PTP Lookup tool or CMS guidelines to confirm that the procedure/modifier combination is, indeed, incompatible with another procedure or procedure/modifier combination performed on the same day.
Identify Missing Modifiers
Next, check for missing modifiers. Determine whether an NCCI-associated modifier is appropriate in your case to bypass the edit. If you performed the billed procedures in different sessions, body parts, or conditions, apply the correct modifiers.
Check Your Supporting Documents
Missing documentation can be the main reason. Therefore, review your supporting documents to make sure they are complete. In simple terms, they should demonstrate the medical necessity of the distinct and separately identifiable services. If they are not complete, gather the patient’s medical records, including history, diagnoses, current condition, and treatment plan.
Take Appropriate Actions & Resubmit the Claim
If you have received denial code 236 due to any of the above reasons, take appropriate corrective actions and resubmit the claim. This includes adding the correct modifier, providing all the supporting documentation, and removing inappropriate CPT code.
File an Appeal (if Necessary)
If you cannot find any justification for the CO 236 denial code or if the payer denies your claim again after resubmission, file an appeal. Submit the necessary documentation with a detailed letter referencing the NCCI edit that supports your claim. Make sure to review the payer-specific policies for filing an appeal and submit your application within the specified timeframe.
Resolve CO 236 Denial Code with MediBillMD
The CO 236 denial code is quite challenging for healthcare providers. The main reason? First, you must be a coding expert to understand the problem and then resolve it using correct modifiers or codes. On top of that, you must be up-to-date with NCCI edits, bundles, and documentation requirements. However, if you find the resolution process too complicated, you can outsource it.
MediBillMD excels in denial management. Our dedicated denial management team, backed by years of industry expertise, uses its knowledge and advanced tools to resolve denial code CO 236 efficiently. From reviewing your denied claim and analyzing NCCI PTP edits to justifying distinct services with proper modifiers and documentation, our denial management services take care of everything so you can receive faster payments. Partner with our experts to reduce not only your CO 236 denials but other issues as well.
