189Denial Code (CARC)Active
CO 189 Denial Code - Fix Unlisted Procedure Code
Code 189 means you billed a 'not otherwise classified' or 'unlisted' procedure code when there is an existing specific code for the service or procedure you provided. This indicates the payer believes a more appropriate code is available and should be used instead.
Who Pays: Group Code Liability
Liability under code 189 generally falls under CO, meaning it is a contractual write-off and the patient cannot be billed for this amount. However, if the unlisted code was used due to lack of provider awareness, it might be worth confirming if resubmission is possible.
Why Claims Get Code 189
- Selecting an unlisted CPT/HCPCS code when a specific code exists.
- Not checking the latest coding guidelines for the most accurate code.
- Using outdated coding resources, leading to incorrect code selection.
- Relying on software suggestions without verification.
- Ignoring payer-specific coding preferences and guidelines.
How to Fix & Resubmit
- Verify if a specific procedure code exists for the service provided.
- Check the payer's coding guidelines for the procedure in question.
- If a specific code is available, prepare a corrected claim using the right code.
- Contact the payer to confirm if resubmission is allowed and if any documentation is required.
- Submit the corrected claim with any necessary supporting documentation.
Corrected Claim or Appeal?
If a specific code is available, a corrected claim should be submitted. A formal appeal is generally unnecessary unless you believe the payer's determination is incorrect.
Preventing Future 189 Denials
- Regularly update and review coding resources to ensure correct code selection.
- Conduct periodic training on coding guidelines and updates for billing staff.
- Implement a coding verification step before claim submission to catch unlisted codes.
- Use payer resources and guidelines to guide code selection whenever available.