http://www.wpc-edi.com/reference/

For 1-7, Using the website above:

• Determine what these denial / adjustment codes mean.
• Come up with a specific, real-world example of when you'd get this denial.

Note: Prefix CO means contractual obligation (provider's responsibility) & PR=patient responsibility This is who the insurance company feels should be responsible for payment!

1. PR01
2. CO59
3. PR27
4. CO197
5. CO6
6. CO10
7. PR3

For 8-12:

• Determine why each of the following denied (what the denial code means)
• State what you'd do next. Your options:
• Resubmit the claim- and what are you changing on the claim form?
• Appeal it- not changing the claim form but saying it needs to be paid. Why is it supposed to be paid?
• Write it off- why?
• Bill the patient- why?

1. 54150 circumcision denied as PR-96
2. Drainage of ovarian cyst 58925 denied when billed with total abdominal hysterectomy 58150 as CO-59
3. Medicare patient had nutritional therapy 97803 for obesity denied as CO-50
4. Medicare patient had skin tags 11200 denied as PR-50
5. Patient had a chest x-ray done 71046 and diagnosis reported on the claim form was enlarged lymph nodes. You look in the chart and notice the patient also has SOB and productive cough documented, but they were not coded. Denied as CO-50