What is Denial Code CO 151?

According to Change Healthcare, 34% of claim denials are absolutely avoidable, with about 86% of them being potentially avoidable. Proper training for your staff, staying up to date with industry standards and reforms, and utilizing third party clearinghouse systems are just a few essential tools you should have in your medical billing tool belt.

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But the easiest way to keep your claim denial rates low, is by understanding the different denial codes and what they stand for. The better acquainted you and your team are with common denial codes, the less likely you will run into them repeatedly. And if you do, you’ll know exactly how to appeal them.

One denial code that we see healthcare providers running into frequently is CO 151. Let’s delve into what this denial code means and some steps you can take to fix it.

If you receive denial code CO 151, here are some things to keep in mind. The “CO” in this code stands for “Contractual Obligation”. This particular Claim Adjustment Reason Code is a valid contract between a healthcare provider and an insurance company. The contract defines the agreement between both parties on what services they will cover. Note that this makes it so providers are unable to assign financial responsibility onto the patient.

The exact definition for CO 151 is that the payer finds that the information submitted in the claim doesn’t support the frequency of services. In other words, a provider performs a service more times than the patient’s coverage allows.

So what should you do when you run into this denial code?

CO 151 can be a tricky denial code to work with, but don’t let that discourage you! There are a few actions you can take in order to have your claim processed.

You can look over your claim to check for any frequency limits listed in the Local Coverage Determination (LCD). For reference, LCDs are decisions made by a Medicare Administrative Contractor whether to cover a particular item or service. Anyway, you can then either adjust the amounts or appeal the claim with the proper documentation to support the medical necessity.

You can check the Medically Unlikely Edit (MUE) tool, developed by the Centers for Medicare and Medicaid Services. This provides information on the maximum allowable units of a service that a provider might report in most circumstances.

You can adjust the date span based on the medical records available to the supplier.

You can make sure questions on Certificate of Medical Necessity (CMN) are qualifying. However, this is only required for dates of service before January 1, 2023.

If none of these actions are successful, you may submit an LCD redetermination request including all relevant supporting documentation as to why the number of services or procedures is necessary.

By understanding the causes of claim denials and the codes that define them, you can begin to avoid some of the more common ones. By doing this, you can enhance your chances of successful claim submissions and decrease your denial rates. By communicating successfully with both healthcare providers and insurance companies, you can continue to collect on revenue in a timely manner for your practice, allowing for the best outcome for patients and providers alike!

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