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CO-234
Recoverability: Medium
This procedure is not paid separately
The payer treats this procedure as part of another service and never pays it on its own line. The accompanying remark code indicates the payer's reasoning.
Why this happens on dental claims
- Local anesthesia, irrigation, pulp caps, bases, and liners treated as inclusive to restorations and surgery
- Suture removal and routine post-operative visits within a global period after extractions or surgery
- Adjunctive services such as occlusal adjustment billed alongside the definitive procedure
How to appeal CO-234
- Check the remark code to see which service the payer considers this a component of
- Compare against the CDT descriptors, since some services are separately reportable by definition even when plans bundle them
- Appeal when the service was performed at a separate visit or a separate site from the procedure it was folded into
- Determine whether your participation agreement allows patient billing for bundled services, and set expectations accordingly
How to prevent it
- Know which adjunctive codes each major payer never pays separately, and fold that into fee scheduling and patient estimates
Related codes
How much CO-234 money is sitting in your remittances?
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