186Denial Code (CARC)Active
CO 186 Denial Code - Level of Care Adjustment Fix
Code 186 signifies that there was an adjustment made due to a change in the level of care provided to the patient. This typically means the care level billed does not match the care level authorized or documented.
Who Pays: Group Code Liability
For code 186, the group code is usually CO, meaning it's a contractual adjustment where the provider writes off the amount and the patient is not billed.
Why Claims Get Code 186
- The billed service was provided at a different level of care than what was authorized.
- Documentation did not support the billed level of care.
- A change in the patient's condition resulted in a different care level than initially billed.
- The payer's policy requires a different level of care for the diagnosis submitted.
- Coding errors led to the wrong level of care being billed.
How to Fix & Resubmit
- Verify the level of care billed against the patient's medical records and authorization.
- Check the payer's policy on level of care requirements for the diagnosis involved.
- If documentation supports a different level, update the claim with the correct level of care.
- Submit a corrected claim if the level of care was billed incorrectly.
- If the payer's decision seems incorrect, prepare an appeal with supporting documentation.
Corrected Claim or Appeal?
Submit a corrected claim when the billed level of care was wrong. If the level of care was correct but denied, appeal with documentation showing medical necessity or authorization.
Preventing Future 186 Denials
- Ensure accurate documentation of the patient's level of care and condition changes.
- Verify authorization for the specific level of care before billing.
- Regularly review payer policies regarding level of care requirements.
- Train staff on documenting level of care changes promptly and accurately.