OA-219: Based on Extent of Injury

What Does OA-219 Mean?

With OA (Other Adjustments), the injury extent assessment was applied during coordination of benefits or as an informational adjustment.

CARC 219 indicates the payer reduced or denied the claim based on their determination of the extent of the patient's injury. This code is most common in workers compensation and liability insurance contexts where the payer evaluates the severity of the injury and the appropriateness of treatment relative to that severity.

The payer may have determined that the treatment provided exceeded what was reasonable given the injury's extent, or that the injury has reached maximum medical improvement (MMI) and further treatment is not warranted. This code often involves clinical assessment by the payer's medical review team.

Common Causes

How to Resolve

1. Review the assessment Understand the injury determination.
2. Appeal if warranted Submit clinical evidence to the appropriate payer.

How to Prevent OA-219

• Document injury severity for all payers in the coordination chain

General Prevention

• Ensure injury documentation supports the full scope of treatment provided
• Coordinate extent of injury determinations across all payers

Also Filed As

The same CARC 219 may appear with different Group Codes:

Related Denial Codes