How To Fix Denial Code 182 | Common Reasons, Next Steps & How To Avoid It

Denial Code 182 means that the procedure modifier used on the date of service was invalid. In this article, we will provide a description of denial code 182, common reasons for its occurrence, next steps to resolve the denial, tips on how to avoid it in the future, and examples of denial code 182 cases.

2. Description

Denial Code 182 is a Claim Adjustment Reason Code (CARC) that indicates the procedure modifier used on the date of service was invalid. This means that the modifier code submitted with the claim does not match the accepted modifier codes for the specific procedure performed. As a result, the claim is denied, and the payment is not made by the insurance company.

2. Common Reasons

The most common reasons for denial code 182 are:

1. Incorrect Modifier Usage: One of the main reasons for denial code 182 is the incorrect usage of procedure modifiers. Providers may use modifiers that are not applicable to the specific procedure or fail to include required modifiers. This can lead to denials as the insurance company does not recognize the submitted modifier.
2. Outdated Modifier Codes: Another reason for denial code 182 is the use of outdated or invalid modifier codes. Modifier codes can change over time, and it is essential for providers to stay updated with the latest coding guidelines. Using obsolete modifier codes can result in denials.
3. Missing or Incomplete Documentation: Insufficient documentation supporting the use of a specific modifier can also lead to denial code 182. If the medical records do not clearly justify the need for the modifier, the claim may be denied.
4. Incorrect Coding: Denial code 182 can occur when there is an error in the coding process. If the procedure code or the modifier code is incorrectly assigned, it can result in a denial.

3. Next Steps

To resolve denial code 182, follow these next steps:

1. Review the Claim: Carefully review the denied claim to identify the specific procedure and modifier code that triggered the denial. Cross-reference the codes with the accepted modifier codes for the procedure to determine if an incorrect or invalid modifier was used.
2. Verify Modifier Guidelines: Consult the current coding guidelines and documentation requirements to ensure that the modifier used aligns with the specific procedure performed. Check for any updates or changes to the modifier codes that may have caused the denial.
3. Provide Additional Documentation: If the denial was due to insufficient documentation, gather any additional supporting documentation that justifies the use of the modifier. This may include medical records, operative reports, or any other relevant documentation.
4. Correct Coding Errors: If the denial was a result of coding errors, correct the coding by assigning the appropriate procedure and modifier codes. Ensure that the codes accurately reflect the services provided and are in compliance with coding guidelines.
5. Resubmit the Claim: Once the necessary corrections and documentation have been gathered, resubmit the claim to the insurance company for reconsideration. Include a clear and concise explanation of the changes made and the supporting documentation provided.
6. Follow Up with the Insurance Company: If the claim is still denied after resubmission, follow up with the insurance company to understand the specific reason for the denial. This will help identify any additional steps that may be required to resolve the denial.

4. How To Avoid It

To avoid denial code 182 in the future, consider the following tips:

1. Stay Updated with Coding Guidelines: Regularly review and stay updated with the latest coding guidelines and modifier code changes. This will ensure that you are using the correct and valid modifier codes for the procedures performed.
2. Double-Check Modifier Usage: Before submitting a claim, double-check the modifier usage to ensure that the modifier is applicable to the specific procedure and is supported by appropriate documentation.
3. Improve Documentation Practices: Maintain thorough and accurate documentation that clearly justifies the use of any modifiers. Ensure that the medical records provide sufficient information to support the need for the modifier.
4. Implement Quality Assurance Measures: Establish quality assurance measures within your coding and billing processes to catch any coding errors or incorrect modifier usage before claims are submitted.

5. Example Cases

Here are two examples of denial code 182:

• Example 1: A provider submits a claim for a surgical procedure with a modifier indicating that it was performed on an emergency basis. However, the medical records do not support the emergency nature of the procedure, leading to denial code 182.
• Example 2: A provider mistakenly uses an outdated modifier code for a specific procedure. As a result, the claim is denied under code 182 due to the use of an invalid modifier.

Source: Claim Adjustment Reason Codes