Common Rejections - Missing/Invalid Procedure Code

Missing/Invalid Procedure Code

Rejection Message:

Procedure code rejections are usually flagged because the claim contains an invalid Procedure code for the Date of Service. This could be because the procedure code used was not an active code for the submitted date of service, or the incorrect procedure code was entered. The clearinghouse rejection message contains the rejected code in parenthesis next to Bad Data.

Example: Emdeon Reject LINE LEVEL PROCEDURE CODE IS MISSING OR INVALID (Bad Data: 5010F )

• This rejection is stating that 5010F is an invalid code and should be reviewed.

First verify that the code in question was an active code for the Date of Service in question; please consult a procedure code handbook or other online source. It is important that procedure codes may be updated at various points during the year.

Once the correct code has been located, it will need to be altered in the charge window. After selecting the valid code the claim can be rebuilt and resent.

Procedure codes (CPT and HCPCS Codes), along with Diagnosis (ICD-10) codes, are typically updated every year. The user will want to be certain that they are not using an outdated code.