EOB denial code CO-11: what it means

What it means

The insurer says the diagnosis on the claim does not justify the procedure that was billed.

Contractual Obligation — an adjustment the provider agreed to by contract. The patient is generally not billed for CO amounts.

Official X12 description

“The diagnosis is inconsistent with the procedure”

Typical cause

The diagnosis code submitted does not support medical necessity for the procedure, or a more specific diagnosis was needed.

What to do next

1. 1Ask your provider whether the correct, most specific diagnosis code was submitted.
2. 2If the diagnosis was incomplete, request a corrected claim.
3. 3If the procedure was medically necessary, your provider can submit supporting documentation.