CARC 181
Code was not valid on that date
The procedure code did not exist, or had been retired, on the date the service was performed.
Why you actually get this
- Code sets changed and the fee schedule was not updated.
- A service delivered near a code-set changeover was billed with the wrong year's code.
- A retired code remained in a template or favourites list.
How to check whether it’s correct
- 01Confirm which code was valid on the date of service, not today.
- 02Review whether the practice's code set was updated at the last changeover.
Usually worth appealing
Correctable. More usefully, a cluster of these points at a code set that was never updated, which will keep producing denials until someone fixes the source.
Often arrives with
Seeing a lot of these?
A single denial is a claim to work. A pattern of the same denial is a process to fix, and the two need completely different responses. A free panel reads ninety days of your claims data and shows which codes actually recur for you.
Claim Adjustment Reason Codes are maintained by X12 as External Code List 139. The official description of this code is theirs and is not reproduced here. Check the authoritative list for current wording and status.