CO-04 defines the claim denial as procedure code or cpt code is inconsistent with modifier used.
Modifiers are used in claim to enhance and add more clarification of procedure or services used in medical care.
If we received this denial we need to follow some steps which are mentioned as below,
- Need to check with the coding department to confirm whether the modifier used is appropriate or not.
- If the coding team suggests a new modifier, we need to update the same rebill the claim.
- If modifier is correct as per the service provided in that case need to call insurance and ask them to reprocess the claim as it was wrongly denied.
- Sometimes due to medical services complications, procedure not compatible with modifier in that case need to call insurance as ask for address and other details to resubmission of the claim with proper medical documents with appeal letter for reprocess the claim.
- Also, some websites available which provide correct information of procedure and modifiers compatibility, check them also.