CARC 9
Diagnosis conflicts with the patient's age
The diagnosis reported is not one the payer expects for a patient of this age.
Why you actually get this
- A date of birth error at registration.
- A diagnosis code selected from a list without checking its age band.
How to check whether it’s correct
- 01Verify the date of birth against the record.
- 02Confirm the diagnosis code is the correct one for this presentation and age.
Usually worth appealing
Usually corrected rather than appealed. Where the diagnosis is right and the edit is wrong, documentation establishing the clinical picture is what moves it.
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.