122Denial Code (CARC)Active
CO 122 Denial Code - Fix Psychiatric Reductions
Code 122 indicates that there has been a reduction in payment due to psychiatric services being adjusted. This means the payer has applied a policy that reduces reimbursement for psychiatric care, possibly due to a contracted rate or coverage limitations.
Who Pays: Group Code Liability
For code 122, the group code CO typically applies, meaning the provider must write off the adjusted amount and cannot bill the patient for the difference. Check the payer's policy to confirm if CO or another code applies.
Why Claims Get Code 122
- The payer has a contractual agreement that includes reduced rates for psychiatric services.
- The services provided exceeded the payer's allowable limits for psychiatric care.
- The claim included psychiatric services that are only partially covered by the patient's plan.
- A coding error led to the incorrect categorization of the services as psychiatric.
- The patient's plan has a specific reduction policy for psychiatric services.
How to Fix & Resubmit
- Verify the payer's policy on psychiatric reductions to ensure the adjustment is valid.
- Check the contract terms to confirm the allowable rates for psychiatric services.
- Review the claim to ensure that all services were coded correctly as psychiatric.
- If coding was incorrect, adjust the codes and submit a corrected claim.
- If the adjustment is not contractually justified, prepare to file a formal appeal with supporting documentation.
Corrected Claim or Appeal?
Submit a corrected claim if coding errors caused the denial. If the adjustment is contractually unjustified, a formal appeal with documentation is necessary. If valid per contract, no appeal is warranted.
Preventing Future 122 Denials
- Ensure accurate coding of psychiatric services during claim submission.
- Regularly review and understand payer contracts regarding psychiatric service rates.
- Train billing staff on identifying payer-specific psychiatric reduction policies.
- Implement pre-submission checks to catch potential coding errors for psychiatric claims.