Denial Code 199 means that the revenue code and procedure code on a claim do not match. This discrepancy can lead to the denial of the claim by the insurance company. In this article, we will provide a description of denial code 199, common reasons for its occurrence, next steps to resolve the issue, tips on how to avoid it in the future, and examples of cases involving denial code 199.
2. Description
Denial Code 199 is a specific denial code that indicates a mismatch between the revenue code and procedure code on a claim. The revenue code represents the specific service or item provided, while the procedure code describes the specific procedure or treatment performed. When these codes do not align, it can result in the denial of the claim by the insurance company.
2. Common Reasons
There are several common reasons why denial code 199 may occur:
- Incorrect Coding: One of the most common reasons for denial code 199 is incorrect coding. This can happen when the person responsible for coding the claim enters the wrong revenue code or procedure code, leading to a mismatch between the two.
- Lack of Documentation: Another reason for denial code 199 is a lack of supporting documentation. If the claim does not include sufficient documentation to justify the relationship between the revenue code and procedure code, the insurance company may deny the claim.
- Billing Errors: Billing errors, such as typos or transposed numbers, can also result in denial code 199. These errors can lead to discrepancies between the revenue code and procedure code, causing the claim to be denied.
- Outdated Codes: Denial code 199 may occur if outdated or invalid codes are used. It is essential to use the most up-to-date codes to ensure accurate billing and avoid claim denials.
3. Next Steps
If you receive denial code 199, here are the next steps to resolve the issue:
- Review the Claim: Start by reviewing the claim to identify the specific revenue code and procedure code that do not match. This will help you pinpoint the exact issue and determine the necessary steps to rectify it.
- Correct the Coding: If the mismatch is due to incorrect coding, make the necessary corrections to ensure that the revenue code and procedure code align. Double-check the codes to ensure accuracy before resubmitting the claim.
- Gather Supporting Documentation: If the denial is due to a lack of documentation, gather the necessary supporting documents to justify the relationship between the revenue code and procedure code. This may include medical records, test results, or other relevant documentation.
- Resubmit the Claim: Once you have made the necessary corrections and gathered the required documentation, resubmit the claim to the insurance company. Include a cover letter explaining the reason for the resubmission and any additional information that supports the claim.
- Follow Up: After resubmitting the claim, follow up with the insurance company to ensure that it is being processed correctly. If there are any further issues or questions, address them promptly to expedite the resolution process.
4. How To Avoid It
To avoid denial code 199 in the future, consider the following tips:
- Ensure Accurate Coding: Take the time to accurately code each claim, paying close attention to the revenue code and procedure code. Double-check for any errors or discrepancies before submitting the claim.
- Provide Sufficient Documentation: Include all necessary supporting documentation with each claim to justify the relationship between the revenue code and procedure code. This will help prevent denials due to a lack of documentation.
- Stay Updated on Coding Changes: Stay informed about any changes or updates to coding guidelines and ensure that you are using the most current codes. Regularly review and update your coding practices to avoid using outdated or invalid codes.
- Implement Quality Control Measures: Establish quality control measures within your billing and coding processes to catch any errors or discrepancies before claims are submitted. This may include double-checking codes, conducting regular audits, and providing ongoing training to staff.
5. Example Cases
Here are two examples of denial code 199:
- Example 1: A healthcare provider submits a claim with a revenue code indicating a surgical procedure, but the procedure code entered corresponds to a diagnostic test. This mismatch between the revenue code and procedure code results in denial code 199.
- Example 2: A billing specialist accidentally transposes numbers when entering the revenue code and procedure code on a claim. As a result, the codes do not match, leading to denial code 199.
