835 Denial Combination

CO-16+N249

CO

Contractual Obligation · Claim-Level Adjustment

Missing Information

What This Combination Means

The claim was denied due to missing, incomplete, or invalid identification information for the assistant surgeon. This is a submission error where the assistant surgeon's NPI or other primary identifier was either not included, incorrectly formatted, or does not match payer records. The provider is contractually obligated to write off the adjustment amount and must correct the assistant surgeon information before resubmitting.

Financial Responsibility

provider writeoff

The provider must write off the denied amount per contractual obligation with the payer and cannot balance bill the patient. This adjustment results from a correctable billing error related to assistant surgeon identification.

N/A

Appeal Success

3-5 business days (corrected claim)

Avg. Resolution

Medium

Difficulty

No

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-16+N249 combination — not generic advice.

Not Appealable:This is a correctable submission error requiring claim correction and resubmission rather than appeal, as the issue is missing or invalid data rather than a clinical or payment policy dispute.
  1. 1

    Verify the assistant surgeon's complete NPI and identification details

    Confirm the assistant surgeon's National Provider Identifier (NPI) is valid, active, and matches the provider who performed the service on the date of service

  2. 2

    Update claim line with complete assistant surgeon identifier in appropriate field

    Enter the assistant surgeon NPI in the designated assistant surgeon field (typically Loop 2310B SBR segment or NM109 qualifier AS) with correct modifier 80, 81, or 82 on the procedure line

  3. 3

    Submit corrected claim with frequency code 7

    File as a replacement claim to correct the missing/invalid assistant surgeon identifier, ensuring all other claim elements remain accurate and consistent with original submission

Specialty Context

How CO-16+N249 typically presents across different practice types.

Dental

Medical

Common in surgical specialties including general surgery, cardiothoracic surgery, orthopedic surgery, and neurosurgery where assistant surgeons are frequently utilized. Ensure modifier 80 (assistant surgeon), 81 (minimum assistant surgeon), or 82 (assistant surgeon when qualified resident not available) is paired with valid assistant surgeon NPI.

Behavioral Health

Individual Code References

View the standalone definition for each code in this combination.

CARC 16RARC N249

Medicare Contractor Guidance for CARC 16

FCSO + Noridian + uhc + aetna + bcbs_az

This RUC is received when a claim is submitted with missing, incorrect, or invalid information. For details pertaining to your claim, please refer to the remittance advice remark codes (RARCs) on the remittance advice (RA).

How to Prevent CARC 16 Denials

  • ✓

    Review the RARC on the remittance advice to identify which specific field has the error.

  • ✓

    Per Medicare guidelines, claims must be filed no later than 12 months after the date of service. RUCs are not considered filed/submitted.

CMS guidelines for completion of form CMS-1500 in the Medicare Claims Processing Manual (100-04), Chapter 26SPOTFee Schedule Lookup ToolCMS laboratory demographics lookupModifier lookup toolNoridian Medicare PortalNMPIVRSame or SimilarPECOSPDAC

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Synthesized from official definitions — not from training data

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