CARC 59 Active

PR-59: Multiple/Concurrent Procedure Rules Applied

TL;DR

Patient responsibility — review the adjustment and determine if the patient truly owes this amount.

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-59 Mean?

With PR (Patient Responsibility), the CARC 59 adjustment for multiple/concurrent procedure rules applied shifts the financial impact to the patient. Before billing the patient, verify that the denial reason is valid. if the underlying issue can be corrected, resubmit the claim first to potentially eliminate the patient's liability.

CARC 59 indicates multiple/concurrent procedure rules applied. The payer's adjudication logic determined that this service or procedure is included within another service that was billed on the same claim or a related claim.

Common scenarios that trigger this adjustment include: medicare or payer applied MPPR reducing payment for additional procedures performed during the same session; Secondary and subsequent surgical procedures reduced by 50% per multiple surgery rules; Technical component of additional diagnostic imaging reduced per MPPR rules. The group code paired with CARC 59 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, OA indicates a coordination of benefits or other payer adjustment, PR shifts it to the patient.

How to Resolve

  1. Review the adjustment Examine the PR-59 adjustment and any RARC codes to understand the basis for the patient responsibility.
  2. Verify the adjustment is correct Confirm the PR designation and amount are appropriate based on the patient's plan benefits.
  3. Appeal if incorrect If the adjustment appears incorrect, file an appeal with supporting documentation.
  4. Collect from the patient if valid If the adjustment is confirmed correct, generate a patient statement and follow standard collection procedures.
Do Not Appeal This Code

Multiple/Concurrent Procedure Rules Applied 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-59

Also Filed As

The same CARC 59 may appear with different Group Codes:

CO-59 OA-59

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://www.mdclarity.com/denial-code/59
  3. https://www.hhs.gov/guidance/document/claim-adjustment-reason-code-carc-used-therapy-claims-subject-multiple-procedure-payment-1
  4. Codes maintained by X12. Visit x12.org for official definitions.