Tuesday, November 8, 2011

Avoid CO-16 Denials for Missing Information (Immunizations/Injectible Drugs)

As you know, the fall is flu shot season.  When billing for an immunization, such as a flu shot, CMS requires the NDC code to be submitted along with the claim.  We recently submitted a Medical Billing Tip to our software vendor, and won the contest for the month of November.  Granted, this is specific to Kareo, but it may apply to many other medical billing software platforms as well.

Avoiding CO-16 Denials for Missing Information

CMS requires that immunizations and injectible drugs include the 11 digit NDC code be submitted on the claim.  The FDA website and the packaging label generally only list 10 digits.  The NDC code is a unique 10 digit, 3-segment number.  The first segment is the labeler code, the second segment is the product code and the third is the package code.  The configuration will be in one of the following formats:

4-4-2 or 5-3-2 or 5-4-1

The code submitted must use the following format:  5-4-2

Therefore, when you enter the NDC code in the Kareo procedure file, follow the format rule of 5-4-2.

On a code on the packaging label is 4-4-2, you enter a leading zero in the first segment.
On a code that is 5-3-2, enter a leading zero on the second segment.
On a code that is a 5-4-1, enter a leading zero on the third segment.

This will stop any CO-16 denials for missing information.

Bob Nichols
Medical Billing Services & Solutions
Chesapeake, VA


  1. Should also include making sure people can get to doctors and specialists. I have medicaid, yet I had to put off a doctor's appointment last month because I didn't have the cab fair to get there, and the bus doesn't run anywhere near it. My other half is supposed to go see a Neuro, but it's a five to six hour bus ride each way, and the bus here (to our area)runs from 6am to 7:30pm there's no way to get him there and back. This is the only Neuro in the area that takes his medicaid HMO. This site helps me in my essay writing process.

  2. Claim denials due to missing information is very common in the field of healthcare. Physicians that do billing themselves generally do such errors. So outsourcing Medical Billing Services is a great option. Your post is very informative and helpful for the experts of billing and coding.