CARC 240 Active

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

TL;DR

Patient charges for a coding mismatch are unusual. Correct the data and request reprocessing.

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-240 Mean?

With PR, the patient is responsible due to the data mismatch. This is unusual for 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.

How to Resolve

  1. Correct the data Fix the birth weight/diagnosis mismatch.
  2. Request reprocessing Resubmit and request patient charges be reversed.
Do Not Appeal This Code

The diagnosis code is inconsistent with the documented birth weight. Correct the diagnosis code or birth weight to ensure consistency and resubmit the claim.

How to Prevent PR-240

Also Filed As

The same CARC 240 may appear with different Group Codes:

CO-240 OA-240

Related Denial Codes

PR-4 — Procedure Code Inconsistent with Modifier PR-5 — Procedure Code Inconsistent with Place of Service PR-6 — Procedure/Revenue Code Inconsistent with Patient Age PR-7 — Procedure/Revenue Code Inconsistent with Patient Gender PR-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.