CARC 231 Active

PR-231: Mutually Exclusive Procedures

TL;DR

The patient was charged for a mutually exclusive procedure. Review whether a modifier override can resolve the denial.

Action
Review & Decide
Who Pays
Patient
Appeal
No
Patient Impact
Direct Financial
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 PR-231 Mean?

With PR, the patient is responsible for the denied mutually exclusive procedure. This is unusual for a coding edit and may need review.

CARC 231 indicates that two or more procedures billed on the same claim are classified as mutually exclusive per the National Correct Coding Initiative (NCCI) or the payer's own coding edits. Mutually exclusive procedures are those that, by definition, cannot reasonably be performed at the same session on the same patient — such as two different approaches to the same anatomical site or two procedures that represent alternative methods for the same clinical objective.

The payer will typically pay the higher-valued procedure and deny the mutually exclusive one. This differs from bundling (where one procedure is a component of another) — mutually exclusive means the two procedures represent contradictory approaches.

How to Resolve

  1. Check for modifier overrides Determine if the denial can be resolved with correct modifiers.
  2. Collect if unresolvable If the procedures are truly mutually exclusive, communicate the charges to the patient.
Do Not Appeal This Code

Mutually Exclusive Procedures grouped under PR places the financial responsibility on the patient. The specific reason depends on the context of this adjustment — review any accompanying RARC codes for detail. Because this represents a placement of responsibility rather than a coverage denial, an appeal isn't the right action; verify the placement is correct before billing the patient.

How to Prevent PR-231

Also Filed As

The same CARC 231 may appear with different Group Codes:

CO-231 OA-231

Related Denial Codes

PR-13 — Date of Death Precedes Date of Service PR-14 — Date of Birth Follows Date of Service PR-19 — Workers' Compensation Claim PR-20 — Liability Carrier Responsible PR-21 — No-Fault Carrier Responsible

Sources

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