How To Fix Denial Code P14 | Common Reasons, Next Steps & How To Avoid It

Denial Code P14 means that the benefit for a particular service is already included in the payment or allowance for another service or procedure that was performed on the same day. This denial code is typically used in Property and Casualty insurance claims. In this article, we will explore the description of denial code P14, 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 P14 is a specific Claim Adjustment Reason Code (CARC) that indicates the benefit for a service has already been accounted for in the payment or allowance for another service or procedure performed on the same day. This code is primarily used in Property and Casualty insurance claims. It is important to refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF) for further details, if available. Denial code P14 is effective from November 1, 2013, and replaces the previously deactivated code W3.

2. Common Reasons

The most common reasons for denial code P14 are:

1. Service Bundling: Denial code P14 often occurs when the insurance company considers the service in question to be bundled with another service or procedure that was performed on the same day. This means that the payment or allowance for the service has already been included in the reimbursement for the other procedure, leading to the denial of separate payment for the specific service.
2. Lack of Documentation: Insufficient or incomplete documentation can also result in denial code P14. If the necessary documentation is not provided to clearly demonstrate the medical necessity and distinctiveness of the service, the insurance company may consider it to be included in the payment for another procedure and deny separate reimbursement.
3. Incorrect Coding: Incorrect coding can lead to denial code P14. If the service is coded in a way that suggests it is already included in the payment for another procedure, the insurance company may deny separate reimbursement based on this coding discrepancy.

3. Next Steps

To resolve denial code P14, the following steps can be taken:

1. Review Documentation: Carefully review the documentation associated with the denied claim. Ensure that all necessary documentation is complete, accurate, and clearly demonstrates the medical necessity and distinctiveness of the service in question. If any documentation is missing or inadequate, gather the required information and submit an appeal with the additional documentation.
2. Appeal the Denial: If you believe that the denial was incorrect, prepare a strong appeal. Clearly explain why the service should be considered separate and distinct from the other procedure performed on the same day. Provide supporting documentation, such as medical records, that clearly demonstrate the medical necessity and unique nature of the service.
3. Consult with the Insurance Company: If there is confusion or disagreement regarding the denial, it may be helpful to directly contact the insurance company’s provider support. Discuss the specifics of the claim and the rationale behind the denial. This communication can lead to a resolution or clarification on how to properly bill and receive reimbursement for the service.

4. How To Avoid It

To avoid denial code P14 in the future, consider the following strategies:

1. Thorough Documentation: Ensure that all documentation is complete, accurate, and clearly supports the medical necessity and distinctiveness of each service provided. Include any relevant information that distinguishes the service from others performed on the same day.
2. Accurate Coding: Assign appropriate and accurate codes to each service. Review coding guidelines and documentation requirements to ensure that the codes accurately reflect the services provided and do not suggest bundling with other procedures.
3. Clear Documentation of Medical Necessity: Clearly document the medical necessity of each service provided. Include detailed explanations and supporting evidence to demonstrate why the service is separate and distinct from any other procedures performed on the same day.

5. Example Cases

Here are two examples of denial code P14:

• Example 1: A patient undergoes a surgical procedure to repair a fractured bone in their arm. During the same surgical session, the surgeon also performs a minor procedure to remove a benign cyst. The insurance company denies separate reimbursement for the cyst removal, citing denial code P14, as the payment for the cyst removal is considered included in the reimbursement for the main surgical procedure.
• Example 2: A patient visits a physical therapist for a session that includes both therapeutic exercises and manual therapy. The insurance company denies separate reimbursement for the manual therapy, stating that it is already included in the payment for the therapeutic exercises, resulting in denial code P14.

Source: Claim Adjustment Reason Codes