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

Rejection Message Rejection Details Resolution

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

Payer Rejection:

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.

Submitter Action:

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

Tip: Most Kareo PM 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.

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

  1. Click Encounters > Track Claim Status.
  2. Look for and double-click on the encounter that needs correcting.
  3. On the Edit Claim window, double-click on the Encounter number.
  4. Click into the appropriate Diag cell to edit
    OR
  5. Click into the Mod cell and replace the modifier, as needed.
    • To delete a modifier, select the modifier and click “Delete” on your keyboard.
  6. Click Save and Rebill.

Then, resubmit all affected claims.