How To Fix Denial Code 240 | Common Reasons, Next Steps & How To Avoid It

Denial Code 240 means that the diagnosis is inconsistent with the patient’s birth weight. This denial code indicates that the billed service does not align with the recorded birth weight of the patient. In this article, we will explore the description of denial code 240, common reasons for its occurrence, next steps to resolve it, how to avoid it in the future, and provide examples to illustrate its application.

2. Description

Denial Code 240 is a specific Claim Adjustment Reason Code (CARC) that signifies an inconsistency between the diagnosis and the patient’s recorded birth weight. This code is typically used in healthcare claims to indicate that the billed service does not align with the documented birth weight of the patient. It serves as a flag for potential errors or discrepancies in the diagnosis and treatment provided.

2. Common Reasons

The most common reasons for denial code 240 are:

1. Incorrect Diagnosis: One of the primary reasons for denial code 240 is an incorrect or mismatched diagnosis. This could occur when the diagnosis code submitted on the claim does not align with the patient’s recorded birth weight. It is crucial to ensure accurate coding and documentation to avoid this denial.
2. Data Entry Errors: Mistakes during data entry can also lead to denial code 240. If the birth weight is incorrectly recorded or entered into the system, it may not match the diagnosis provided, resulting in a denial. It is essential to double-check all data entry to prevent such errors.
3. Lack of Documentation: In some cases, the denial may occur due to insufficient or missing documentation. If the medical records do not clearly indicate the patient’s birth weight or if the documentation is incomplete, the claim may be denied under code 240. It is crucial to maintain comprehensive and accurate medical records to avoid this denial.
4. Inconsistent Reporting: Denial code 240 may also arise when there is inconsistency in reporting the patient’s birth weight across different documents or systems. If the birth weight recorded in the claim does not match the information in the patient’s medical records or other relevant documents, the claim may be denied. It is important to ensure consistency in reporting to prevent this denial.

3. Next Steps

To resolve denial code 240, the following steps can be taken:

1. Review Documentation: Start by reviewing the medical records and documentation related to the patient’s birth weight. Ensure that the recorded birth weight is accurate and matches the diagnosis provided on the claim.
2. Verify Diagnosis Code: Double-check the diagnosis code submitted on the claim to ensure it aligns with the patient’s birth weight. If there is an error or mismatch, correct the diagnosis code accordingly.
3. Submit Additional Documentation: If the denial is due to insufficient or missing documentation, gather any additional records or information that clearly indicate the patient’s birth weight. Submit this documentation along with a properly updated claim to support the accuracy of the diagnosis.
4. Contact the Payer: If there is confusion or disagreement regarding the denial, reach out to the insurance payer’s provider support. Discuss the specifics of the claim, including the diagnosis and birth weight, and seek clarification or guidance on how to address the denial.
5. Appeal if Necessary: If the denial persists despite providing accurate documentation and following the payer’s guidance, consider filing an appeal. Provide all relevant information and supporting documentation to demonstrate the accuracy of the diagnosis and the patient’s birth weight.

4. How To Avoid It

To avoid denial code 240 in the future, consider the following measures:

1. Ensure Accurate Diagnosis: Take care to accurately diagnose the patient and assign the appropriate diagnosis code. Verify that the diagnosis aligns with the patient’s birth weight and other relevant factors.
2. Double-Check Data Entry: Pay close attention to data entry when recording the patient’s birth weight and other information. Verify the accuracy of the entered data to prevent errors that could lead to denial code 240.
3. Maintain Comprehensive Documentation: Maintain thorough and accurate medical records that clearly document the patient’s birth weight and any relevant information. This documentation will serve as evidence to support the accuracy of the diagnosis.
4. Promote Consistency: Ensure consistency in reporting the patient’s birth weight across different documents and systems. Verify that the recorded birth weight matches the information in the medical records and other relevant documents.

5. Example Cases

Here are two examples illustrating denial code 240:

• Example 1: A claim is submitted for a newborn baby with a diagnosis code indicating a respiratory infection. However, the recorded birth weight in the medical records is significantly higher than the average birth weight for a newborn. The claim is denied under code 240 due to the inconsistency between the diagnosis and the birth weight.
• Example 2: In another scenario, a claim is submitted for a premature infant with a diagnosis code indicating a developmental delay. However, the recorded birth weight in the medical records is within the normal range for a full-term baby. The claim is denied under code 240 as the diagnosis does not align with the patient’s birth weight.

Source: Claim Adjustment Reason Codes