CO-236: This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/fee schedule requirements.

Why it fires

• The two procedures form an NCCI Procedure-to-Procedure edit pair
• No valid NCCI-associated modifier, such as 59 or XE/XS/XP/XU, was appended to indicate the services were truly separate and distinct
• A state workers' compensation fee schedule has its own bundling rule that applies

Corrective actions, ranked

1. 1

   Check the NCCI PTP edit table

   Confirm whether this code pair has a modifier indicator of 0 (never separately payable) or 1 (modifier allowed).

2. 2

   Append the correct modifier if supported

   If the indicator is 1 and documentation shows the services were distinct in site, session, or encounter, add the appropriate modifier and resubmit.

3. 3

   Accept the bundle if the indicator is 0

   If the edit does not allow a modifier override, this is correctly bundled and should be written off.

Is it worth appealing

Appeal with documentation only when the NCCI modifier indicator allows an override and the medical record clearly supports the services were separate and distinct.

Modifiers named in these corrective actions

The corrective actions for CO-236 point at these modifiers. Check when each one is appropriate before you append it.

• Modifier 59Distinct procedural service
• Modifier XESeparate encounter
• Modifier XSSeparate structure
• Modifier XPSeparate practitioner
• Modifier XUUnusual non-overlapping service

Other denial codes to check

Codes that share a remark code with this one, or that are reported under the same group code.

• CO-45Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
• CO-97The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
• CO-16Claim/service lacks information or has submission/billing error(s).
• CO-11The diagnosis is inconsistent with the procedure.
• OA-18Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)
• CO-29The time limit for filing has expired.

See every CARC in the dataset