ADCB-Global Service previously paid
The procedure was covered as part of a previouslypaid procedure. The service is not payable as adistinct service.Use correct Modifier or take write off.
ADMD-Invalid Modifier Code Submitted
The modifier submitted is not appropriate for theprocedure. Please
resubmit a corrected claims withthe appropriate modifier.
Duplicate of a Previously Processed claim
As stated in the Ingenix® Coder’s Desk Reference forProcedures, modifier 76 can be used “to identify aprocedure or service that was repeated subsequent tothe original procedure or service” to avoid denial of aduplicate claim with identical Member/DOS/
D54 - Capitated Coverage
The service billed is covered under a capitationarrangement and will therefore not be paid.
Modifier 50 Invalid
Identifies an identical procedure performed bilaterallyduring a single operative session. Do not use when aprocedure code description already identifies theprocedure as being bilateral or where the organ isconsidered midline (ex. bladder, uterus).
Submit Primary EOB
Based on our records, the patient has primaryinsurance other than that managed by CMO. In thiscase, CMO will act as the secondary payor. CMOrequires the primary carrier's EOB to demonstrate ourfinancial obligation.
DGDI - Diagnosis invalid for gender
The diagnosis is not appropriate for the gender of themember. Correct the claim and resubmit to CMO.
Diagnosis Requires 4th/5th DigitCertain ICD-9 codes have varying levels of specificity.CMS guidelines require that these diagnosis codesprovide a 4th or 5th digit to be considered for payment.
DIPC - Invalid ICD9 Procedure Code
The procedure code provided is not valid. Correct theclaim and resubmit to CMO.