Quick Explanation
Denial code CO-84 indicates that the insurance payer has denied payment because the required presurgical screening or preoperative testing was not performed or documented prior to the scheduled surgical procedure. Payers often mandate specific clearance protocols, such as laboratory tests, EKGs, or chest X-rays, to ensure patient safety before surgery. Without proof of these completed screenings within the designated timeframe, the surgical claim or associated pre-op services will be rejected.
Common Causes for CO-84
Denials with code CO-84 typically happen for the following specific reasons:
- The required preoperative clearance tests (such as CBC, EKG, or BMP) were not performed within the payer-specified timeframe before the surgical procedure.
- The presurgical screening was performed by an external primary care physician or facility, but the results and documentation were not integrated into the surgical claim or hospital chart.
- Failure to append the correct ICD-10 encounter codes (e.g., Z01.810 for preprocedural cardiovascular examination) to indicate the visit was for presurgical clearance.
- Lack of documented medical necessity or failure to obtain prior authorization for specific high-cost presurgical screenings required by the payer's medical policy.
How to Prevent CO-84 Denials
To avoid receiving this denial in the future, implement these specific checks:
- Implement a robust preoperative checklist to verify that all payer-mandated screenings are completed, documented, and reviewed before the date of surgery.
- Confirm specific payer policies during the prior authorization process regarding which preoperative tests are required and the acceptable window of time (e.g., 7 to 30 days prior) for them to be performed.
- Establish streamlined workflows to obtain and upload external preoperative clearance records into the patient's electronic health record (EHR) prior to billing.
- Train coding staff to utilize specific preoperative examination ICD-10-CM codes (Z01.810 - Z01.818) to ensure the screening services are correctly linked to the upcoming surgery.
Appeal Letter Template for CO-84
If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.
[Your Practice Header]
[Date]
[Payer Name]
[Appeals Department Address]
RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: CO-84 - The presurgical screening/testing was not conducted
Dear Appeals Department,
I am writing to appeal the denial of the above-referenced claim, which was denied with code CO-84: "The presurgical screening/testing was not conducted".
We are appealing the denial of the services associated with claim [Claim Number], which was denied under code CO-84 for lack of presurgical screening. In accordance with CMS guidelines and accepted standard medical practices, necessary preoperative evaluations and clinical screenings are critical to ensuring patient safety and determining surgical readiness. The required presurgical screening was indeed performed on [Date of Screening] by [Provider/Facility Name], and the patient was clinically cleared for the procedure. We have attached the corresponding medical records, including the laboratory results, EKG tracings, and the signed clinical clearance note, which verify full compliance with preoperative protocols. Given this documentation, we respectfully request that the denial be overturned and the claim be processed for payment.
Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].
We respectfully request that you reprocess this claim for payment.
Sincerely,
[Your Name]
[Title]
[Practice Name]
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