Top 10 Common Denial Codes in Medical Billing

Denials in medical billing occur when a payer rejects a claim for various kinds of reasons, including missing information, coding errors, or a lack of medical necessity as specified in the procedure codes. Healthcare institutions must monitor and evaluate denial trends to discover improvement opportunities.

Commons Denial Codes and Descriptions

Denial code: 18

When the insurance company provides rejection code 18, it means that the claim is a duplicate of one that has already been submitted. The insurance company will compare a claim submitted by a medical provider to previous claims to verify there are no duplicates.

Denial code: 22

Denial code 22 occurs when an insurance company discovers that the patient has extra health insurance that may be responsible for settling the medical claims submitted. When the insurance company discovers that the patient may have additional coverages that need to be invoiced, this is referred to as Coordination of Benefits (COB).

Denial code: 29

When an insurance company rejects a claim, it is usually because the provider did not file the claim by the deadline. The denial code 29 in medical billing indicates this. Each insurance carrier has a deadline for filing claims after service.

Denial code: 45

An insurance company may partially or entirely deny a claim if the amount charged for a certain service exceeds the insurance provider’s maximum permitted or fee schedule, as indicated by denial code 45 in medical billing.

Denial code: 96

In medical billing, a denial code 96 indicates that an insurance company believes a claimed procedure is not medically necessary or does not meet its required criteria. The treatment or service may be seen as experimental or not clinically beneficial to the patient’s situation.

Denial code: 109

When an insurance provider determines that their plan or agreement does not cover a patient’s surgery or medical service, they use denial code 109. The Denial code 109 denotes exclusion from an insurance policy. Insurance companies usually provide thorough lists of benefits and coverage for specific health plans.

Denial code: 197

Medical billing’s denial code 197 indicates that a claim has been denied because the billed service, expense, or operation has not been accepted. In general, this denial indicates that the insurance company rejected or changed the invoiced charges submitted by the provider due to a lack of payment permission.

Denial code: 204

Medical billing denial code 204 indicates that the insurance company packaged or combined the invoiced service, item, or therapy unexpectedly or incorrectly. Alternatively, it is known as the packed service denial code.

Denial code: 252

Medical billing’s denial code 252 indicates a possible issue with the Coordination of Benefits (COB) condition. It happens when a key payer other than the billed insurance provider has already paid for a specific service’s cost.

Denial code: 253

In medical billing, the denial code 253 indicates that a patient has received all allowed benefits or services during a certain period. The insurance policy’s stated time frame, which is often monthly or annually, has reached its limit for the service code for which a bill is issued.