Denials Due to Code Non-Recognition

In some cases you may get a medical billing denial due to non-recognition of the coding used. In a lot of cases, this is due to the medical biller jumping the gun and using a code that was due to be released too early for reimbursement.

Normally when a new code is introduced, an effective date will be set and that is the given date for all service providers to begin using that particular billing code. It is not permissible for carriers to deny claims for no recognition if the code effective date has passed.

There are instances in medical billing where code no recognition is acceptable. A payer can deny a claim with a new code if the effective date has not yet passed. If a code has been released with a release date of January 1, but deemed the effective date to be March 1, then the payer doesn’t have to recognize the code until March 1 and may deny codes until that time permissibly.

Another big reason for denial is no coverage. If a payer rejects your new medical billing code, many times the rejection is due to no coverage. Don’t jump to the conclusion that the company doesn’t recognize the code.

If you find that an insurance company is wrongfully denying your medical billing claims due to wrongful no recognition, there is something you can do. If you can’t work it out with an underwriter via letters/phone calls, you can register a complaint against the company.

View all Articles by: Melissa Clark, CCS-P