CO-157: Service Provided as Result of Act of War

What Does CO-157 Mean?

With CO (Contractual Obligation), the CARC 157 denial for service provided as result of act of war is the provider's contractual responsibility. The patient is not liable for this amount. However, the provider may appeal with supporting clinical or administrative documentation if the denial is believed to be in error.

CARC 157 indicates service provided as result of act of war. The payer determined that the service or a portion of it does not meet coverage criteria under the patient's current plan benefits or the applicable coverage rules.

Common scenarios that trigger this adjustment include: the patient's insurance policy contains an exclusion clause for services resulting from acts of war, and the payer has determined that the treated condition falls under this exclusion; The payer incorrectly classified the cause of the injury or illness as war-related when it was not, triggering an inappropriate exclusion; The claim did not include sufficient information about the cause of injury, and the payer defaulted to a war-related exclusion based on available information. The group code paired with CARC 157 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, OA indicates a coordination of benefits or other payer adjustment, PR shifts it to the patient.

Common Causes

How to Resolve

1. Review the denial Examine the CO-157 denial and any RARC codes to understand the specific basis for the coverage determination.
2. Gather supporting documentation Collect medical records, clinical notes, authorization documents, or other evidence that supports the medical necessity or coverage of the denied service.
3. File the appeal Appeal with documentation that the condition or injury is not the result of an act of war. Include medical records showing the actual cause, external cause codes, and any supporting evidence clarifying the circumstances of the injury or illness.
4. Track the appeal outcome Monitor the appeal status and follow up as needed. If denied again, consider further levels of appeal if available.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-157:

How to Prevent CO-157

• Clearly document the cause of injury or illness in the medical record to prevent misclassification
• Include condition-specific external cause codes (ICD-10 codes) on claims to specify the cause of injury
• Review patient insurance policies for war-related exclusions when treating conditions that could be misclassified
• Ensure claim forms clearly indicate the cause and circumstances of the patient's condition

Also Filed As

The same CARC 157 may appear with different Group Codes:

Related Denial Codes