CO-240: Diagnosis Inconsistent with Patient's Birth Weight
The birth weight and diagnosis code do not match. Correct the data and resubmit.
What Does CO-240 Mean?
With CO, the birth weight/diagnosis mismatch is a coding error. Correct the data and resubmit.
CARC 240 is specific to neonatal and newborn claims where the payer identified a mismatch between the diagnosis codes submitted and the patient's reported birth weight. Certain neonatal diagnosis codes specify birth weight ranges, and the payer validates these against the birth weight on the claim. If the birth weight does not match the diagnosis code's weight range, the claim is denied.
For example, if a very low birth weight diagnosis code (under 1,500 grams) is submitted but the recorded birth weight is 3,200 grams, the claim will be denied under this code. This is typically a coding or data entry error.
Common Causes
| Cause | Frequency |
|---|---|
| Neonatal diagnosis code does not match documented birth weight The ICD diagnosis code indicates a birth weight category that does not match the actual birth weight documented in the medical record | Most Common |
| Birth weight not documented or documented incorrectly The birth weight was either not recorded in the claim data or was entered incorrectly, creating an inconsistency with the diagnosis code | Most Common |
| Incorrect neonatal birth weight ICD code selected The coder selected a birth weight ICD code that does not correspond to the actual weight documented in the newborn's medical record | Common |
| Birth weight field mismatch with diagnosis The birth weight reported in the claim data fields does not align with the birth weight category implied by the diagnosis codes | Common |
How to Resolve
- Verify birth weight Check the medical record for the actual birth weight.
- Correct the mismatch Update the diagnosis code or birth weight to match.
- Resubmit Submit the corrected claim.
The diagnosis code is inconsistent with the documented birth weight. Correct the diagnosis code or birth weight to ensure consistency and resubmit the claim.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-240:
| RARC | Description |
|---|---|
| MA130 | Your claim contains incomplete and/or invalid information, and no appeal rights are afforded. Correct the birth weight or diagnosis code inconsistency and resubmit the claim → |
| N522 | Adjustment based on a review of the coding. Review and correct the neonatal diagnosis/birth weight coding → |
How to Prevent CO-240
- Verify birth weight against neonatal diagnosis codes before claim submission
- Implement claim scrubbing that validates birth weight against diagnosis codes
- Train coding staff on birth weight-specific diagnosis code requirements
General Prevention
- Ensure accurate documentation of birth weight in neonatal medical records
- Train coders on the relationship between birth weight ICD codes and documented birth weights
- Implement automated claim edits that validate birth weight data against neonatal diagnosis codes before submission
- Verify birth weight data entry in both the clinical record and claim fields
- Conduct regular audits of neonatal claims for birth weight/diagnosis consistency
Also Filed As
The same CARC 240 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- https://www.mdclarity.com/denial-code/240
- https://portal.ct.gov/-/media/ohs/health-it-advisory-council/apcd-advisory-group/data-submission-guide-workgroup/meeting-materials/6-30-22/carc-codes_final.pdf
- Codes maintained by X12. Visit x12.org for official definitions.