CO-159: Service Provided as Result of Terrorism

What Does CO-159 Mean?

With CO (Contractual Obligation), the CARC 159 denial for service provided as result of terrorism 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 159 indicates service provided as result of terrorism. 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 for services resulting from acts of terrorism, and the payer determined the treated condition falls under this exclusion; The payer incorrectly classified the cause of the injury as terrorism-related when it was not, triggering an inappropriate exclusion; The payer determines that treatment related to a declared act of terrorism should be covered by a federal program rather than private insurance. The group code paired with CARC 159 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-159 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 terrorism. Include medical records showing the actual cause, external cause codes, and supporting evidence clarifying the circumstances.
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-159:

How to Prevent CO-159

• Document the cause of injury or illness clearly in the medical record to prevent misclassification
• Include appropriate external cause codes on claims to specify the cause of injury
• Review patient insurance policies for terrorism-related exclusions when treating potentially related conditions
• Be aware of federal programs that cover terrorism-related injuries for appropriate referral

Also Filed As

The same CARC 159 may appear with different Group Codes:

Related Denial Codes