835 Denial Combination

CO-57

CO

Contractual Obligation · Service-Line Level Adjustment

What This Combination Means

Level of service billed is not supported by the documentation. The E&M code or service level billed is higher than what the medical record justifies.

55%

Appeal Success

14-21 days

Avg. Resolution

Medium

Difficulty

Yes

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-57 combination — not generic advice.

  1. 1

    Pull the medical record and review the level of decision making, history, and exam documented.

  2. 2

    Determine the correct E&M level supported by the documentation using 2021 E&M guidelines.

  3. 3

    If the higher level is justified, appeal with the complete medical record and a coding rationale.

  4. 4

    If the lower level is correct, resubmit at the corrected E&M code.

  5. 5

    Educate providers on documentation requirements for each E&M level.

Specialty Context

How CO-57 typically presents across different practice types.

Dental

Verify level of service billed is not supported by the documentation per your dental plan contract and documentation requirements.

Medical

Confirm level of service billed is not supported by the documentation 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 by the documentation per MHPAEA standards.

Individual Code References

View the standalone definition for each code in this combination.

CARC 57

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