Author: One o Seven RCM

The CO-45 denial code appears on more remittance advices than almost any other adjustment code in medical billing. It’s not a denial in the way most people think. Your claim was processed and paid; CO-45 just documents the gap between what you billed and what your payer contract allows. According…

Every time you bill CPT code 99213 when the visit actually supports 99214, you lose $39. Do that three times a day, and you’re leaving over $23,000 on the table every year. Not because of a coding mistake. Because of a coding habit. This isn’t about upcoding. It’s about accurate…

Every miscalculated remainder is a billable unit your practice never collects. Uncombined timed services from the same session? That’s revenue you earned but never billed. The 8-minute rule itself isn’t complicated. Applying it correctly across therapists, payers, and session types without letting errors compound is where practices fall apart. If…

The ICD-10-CM code for unspecified abdominal pain is R10.9, classified under Chapter 18 (Symptoms, signs, and abnormal clinical and laboratory findings) within the R10 category for abdominal and pelvic pain. But here’s what most coding references won’t tell you: R10.9 should be your last resort, not your default. The R10…

What is CO-197 Denial Code? CO-197 denial code means your claim was rejected because prior authorization, precertification, or payer notification wasn’t obtained before the service was performed. When this code appears on a remittance, the payer is telling you they never approved the service. They won’t pay for it. This…

Every UTI claim that goes out coded as N39.0 when the provider’s notes say “acute cystitis” is a denial waiting to happen. And it happens constantly. According to OIG audit data, more than 27% of diagnostic coding errors involve nonspecific codes, including UTI classifications. That’s roughly one in four UTI…

Every denied 97162 claim costs your physical therapy practice more than the $101 reimbursement you lost. Factor in the staff time to investigate, appeal, and resubmit, and a single preventable denial can run $30 to $50 in administrative overhead on top of the lost revenue. Multiply that across a month…

Another CO-97 denial. Another claim sitting in your rejection pile. Another hour your team will spend figuring out what went wrong. If you’re seeing CO-97 show up on your remittance advice more than once a month, this isn’t random bad luck. It’s a pattern. And that pattern points to a…