112Denial Code (CARC)Active
CO 112 Denial Code: Service Not Furnished Directly
Code 112 indicates that the service billed was either not provided directly to the patient, or there is no documentation to support that the service was rendered. This adjustment suggests an issue with how the service was performed or recorded.
Who Pays: Group Code Liability
Under group code CO, the provider must write off the amount as a contractual obligation, and the patient cannot be billed. If the payer assigns PR, the patient may be responsible, especially if documentation was patient-provided or required but missing.
Why Claims Get Code 112
- Service was billed but not actually performed directly for the patient.
- Documentation to support the provided service is missing or incomplete.
- The billed service was intended to be indirect, such as a telehealth service without proper documentation.
- Incorrect coding led to an assumption that the service was not direct.
- A clerical error resulted in missing documentation.
How to Fix & Resubmit
- Verify that the service was indeed performed directly for the patient.
- Check the medical records for complete and accurate documentation of the service.
- If documentation is missing, obtain it from the provider or patient and ensure it supports the billed service.
- Submit a corrected claim with the necessary documentation if applicable.
- If the service was not directly provided, adjust the claim as a write-off under CO.
Corrected Claim or Appeal?
Submit a corrected claim if documentation was missing but can be provided. If the service was not directly provided and cannot be documented, the adjustment is valid and should be written off.
Preventing Future 112 Denials
- Ensure all services billed have corresponding documentation in the patient's medical record.
- Train staff to verify documentation requirements before claim submission.
- Implement a checklist for direct services to confirm proper documentation is included.
- Review claims for accuracy and completeness before submission.