CO 223 Denial Code - Understand & Address Adjustments
Code 223 indicates an adjustment due to a mandated federal, state, or local law or regulation that doesn't yet have a specific adjustment code. This code is used when a new regulation requires an adjustment, but no specific code has been created for it yet.
Who Pays: Group Code Liability
Under code 223, the adjustment is typically marked as CO, meaning the provider must write off the amount, and the patient cannot be billed for it. However, if the adjustment is due to a regulation where patient responsibility is mandated, it may be marked as PR, making it billable to the patient. Verify the specific regulation to determine liability.
Why Claims Get Code 223
- A new federal regulation requires a fee adjustment before a specific code is established.
- A state law mandates a change in reimbursement that isn't covered by existing codes.
- Local government regulations impose a new fee structure affecting the claim.
- An emergency regulation temporarily alters billing requirements.
How to Fix & Resubmit
- Review the remittance advice to understand which law or regulation prompted the adjustment.
- Verify the regulatory change with the payer or through official regulatory communications.
- Determine if the adjustment is correct based on the regulation's requirements.
- If the adjustment is incorrect, gather documentation and contact the payer for clarification.
- Submit a corrected claim if the adjustment was applied in error, using appropriate documentation.
Corrected Claim or Appeal?
For code 223, submit a corrected claim if the adjustment was incorrectly applied due to misinterpretation of the regulation. If the adjustment is legitimate under the law, an appeal is not applicable.
Preventing Future 223 Denials
- Stay informed about new federal, state, and local regulations affecting billing.
- Regularly check payer communications for updates on regulatory changes.
- Implement a process for quickly adapting to new billing regulations.
- Train staff to recognize when code 223 might apply and how to handle it.