![Inconsistent Inconsistent](/uploads/1/2/5/3/125383772/296553326.png)
07 The procedure/revenue code is inconsistent with the patient's gender. BS CC - PROCEDURE OR DIAGNOSIS NOT VALID FOR MEMBER'S GENDER 09 The diagnosis is inconsistent with the patient's age. BX MEMBER'S AGE IS NOT VALID FOR SECONDARY DIAGNOSIS 11 The diagnosis is inconsistent with the procedure.
Insurance will deny the claim as Denial Code CO 4 – The procedure code is inconsistent with the modifier used or a required modifier is missing, whenever the procedure code billed with an inappropriate modifier or the required modifier is missing. Modifier: Modifier is a 2 character alpha numeric or numeric code that are used with CPT codes to indicate that a performed service has been altered by some specific circumstance but has not changed in its definition or code. Please take the below action, when you receive the Denial Code CO 4 – The procedure code is inconsistent with the modifier used or a required modifier is missing:. First review and check to see with the coding team that the used modifier is in-consistent or required modifier is missing. Update the appropriate modifier and resubmit the claim (Some insurances, claims should be resubmitted as corrected claim). Or. If you find the claim submitted with an appropriate modifier, but the insurance denied the claim incorrectly.
Then the next step is to reach claims department and send the claim back for reprocessing. If they disagree then the final step is to appeal the claim with supporting documents.