Denial Code 189 means that a claim has been denied because a ‘not otherwise classified’ or ‘unlisted’ procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service. Below you can find the description, common reasons for denial code 189, next steps, how to avoid it, and examples.
2. Description
Denial Code 189 is a Claim Adjustment Reason Code (CARC) that indicates a claim has been denied because a ‘not otherwise classified’ or ‘unlisted’ procedure code (CPT/HCPCS) was billed when there is a specific procedure code available for the procedure or service being claimed. In simpler terms, this means that the claim has been rejected because the provider used a generic or unspecified code instead of a more specific one that accurately describes the procedure or service rendered.
2. Common Reasons
The most common reasons for denial code 189 are:
- Incorrect Coding: Providers may use a generic or unspecified procedure code when there is a specific code available for the procedure or service performed. This can happen due to a lack of knowledge about the specific code or a misunderstanding of the coding guidelines.
- Lack of Documentation: Insufficient documentation to support the use of a specific procedure code can lead to the use of a generic or unspecified code. Without proper documentation, providers may not be able to accurately code the claim, resulting in a denial under code 189.
- Inadequate Communication: In some cases, the denial may occur due to a breakdown in communication between the provider and the billing department. If the provider fails to communicate the specific procedure performed, the billing department may use a generic or unspecified code, leading to a denial.
- Outdated Coding Practices: Providers who are not up-to-date with the latest coding guidelines and updates may continue to use generic or unspecified codes instead of the more specific codes available. This can result in denials under code 189.
3. Next Steps
You can fix denial code 189 as follows:
- Review Documentation: Carefully review the documentation related to the procedure or service performed. Ensure that the documentation supports the use of a specific procedure code and provides sufficient details to accurately code the claim.
- Consult Coding Resources: Utilize coding resources such as the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) to identify the appropriate specific procedure code for the service rendered. Cross-reference the documentation with the coding guidelines to ensure accurate coding.
- Update Coding Practices: Stay updated with the latest coding guidelines and updates. Regularly train and educate coding staff to ensure they are aware of the specific procedure codes available and understand the importance of using them accurately.
- Improve Communication: Enhance communication between the provider and the billing department. Ensure that the provider clearly communicates the specific procedure performed, including any relevant details, to avoid the use of generic or unspecified codes.
- Appeal the Denial: If the denial was issued in error or due to a misunderstanding, prepare a strong appeal with supporting documentation. Clearly explain why the specific procedure code should have been used and provide any additional information that may support the claim.
4. How To Avoid It
You can prevent denial code 189 in the future by following these steps:
- Stay Updated with Coding Guidelines: Regularly review and stay updated with the latest coding guidelines and updates. Familiarize yourself with the specific procedure codes available for the services you provide.
- Improve Documentation Practices: Ensure that your documentation accurately reflects the services rendered. Include all relevant details and supporting information to justify the use of specific procedure codes.
- Enhance Communication: Establish clear lines of communication between the provider, coding staff, and billing department. Encourage open dialogue to ensure that the specific procedure performed is accurately communicated and coded.
- Invest in Training and Education: Invest in ongoing training and education for coding staff to keep them informed about the latest coding guidelines and updates. Provide resources and tools to help them accurately code claims.
5. Example Cases
Below are two examples of denial code 189:
- Example 1: A provider submits a claim for a surgical procedure using a generic or unspecified procedure code instead of the specific code available for that procedure. The claim is denied under code 189, highlighting the need for accurate coding.
- Example 2: A billing department mistakenly uses a generic or unspecified procedure code for a diagnostic test instead of the specific code provided by the provider. The claim is denied under code 189, emphasizing the importance of effective communication between the provider and billing department.
