835 Denial Combination
CO-57+N163
Contractual Obligation · Service-Line Level Adjustment
What This Combination Means
Level of service billed is not supported — the medical record submitted does not substantiate the complexity of care billed. N163 confirms the records are inadequate.
52%
Appeal Success
14-30 days
Avg. Resolution
Medium
Difficulty
Yes
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-57+N163 combination — not generic advice.
- 1
Review the denied claim and the medical record submitted to the payer.
- 2
Identify the specific documentation gap (e.g., insufficient MDM data, missing HPI elements).
- 3
Have the provider create a dated addendum addressing the gap.
- 4
Resubmit the appeal with the supplemented record and an E&M coding rationale.
- 5
Consider provider education on medical decision-making documentation.
Specialty Context
How CO-57+N163 typically presents across different practice types.
Dental
Verify level of service billed is not supported — the medical record submitted does not substantiate the complexity of care billed per your dental plan contract and documentation requirements.
Medical
Confirm level of service billed is not supported — the medical record submitted does not substantiate the complexity of care billed against payer policy and submit corrected claim as needed.
Behavioral Health
Apply behavioral health parity rules and confirm level of service billed is not supported — the medical record submitted does not substantiate the complexity of care billed per MHPAEA standards.
Individual Code References
View the standalone definition for each code in this combination.
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