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THE DIAGNOSIS CODE (_____) AND MODIFIER (__) COMBINATION ARE INAPPROPRIATE

 

Rejection Message

THE DIAGNOSIS CODE (_____) AND MODIFIER (__) COMBINATION ARE INAPPROPRIATE

Rejection Details

This rejection indicates that (per the payer) one of the diagnosis codes submitted on the claim should not be paired with a particular modifier.

The rejection message itself will specify the pairing that is incorrect.

Resolution

Please verify that the procedure modifiers included on the claim are valid for the service date per payer billing guidelines.

Follow the instructions below to edit the diagnoses or modifiers included on an encounter:

  1. Click Encounters > Track Claim Status. The Find Claim window opens.
  2. Look for and double-click on the encounter that needs correcting. The Edit Claim window opens.
  3. Double-click on the Encounter number.  The Edit Encounter window opens.
  4. Click into the appropriate Diag or Mod cell to edit
    • To delete, select the diagnosis or modifier and click Delete on your keyboard.
  5. Click Save & Rebill.

Then, resubmit all affected claims.

Encounter_DiagMod.png

Tip: Most subscription levels include access to a free code scrubbing tool on the Encounter. Utilizing this feature for all encounters can help prevent code rejections.

Note: Kareo Support cannot provide coding assistance. Please contact your biller/coder with any CPT or ICD code questions.