CARC 240 Active

OA-240: Diagnosis Inconsistent with Patient's Birth Weight

TL;DR

The birth weight/diagnosis mismatch was flagged during COB. Correct and resubmit.

Action
Verify & Resubmit
Who Pays
Depends
Appeal
No
Patient Impact
Indirect
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does OA-240 Mean?

With OA, the mismatch was flagged during coordination of benefits.

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
Informational adjustment for neonatal coding inconsistency The payer reports the birth weight/diagnosis inconsistency as an OA informational adjustment Common

How to Resolve

  1. Correct the data Fix the birth weight or diagnosis code.
  2. Resubmit Submit the corrected claim.
Do Not Appeal This Code

Correct the birth weight/diagnosis inconsistency and resubmit.

How to Prevent OA-240

General Prevention

Also Filed As

The same CARC 240 may appear with different Group Codes:

CO-240 PR-240

Related Denial Codes

OA-4 — Procedure Code Inconsistent with Modifier OA-5 — Procedure Code Inconsistent with Place of Service OA-6 — Procedure/Revenue Code Inconsistent with Patient Age OA-7 — Procedure/Revenue Code Inconsistent with Patient Gender OA-8 — Procedure Code Inconsistent with Provider Type/Specialty

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/240
  3. 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
  4. Codes maintained by X12. Visit x12.org for official definitions.