CO 159 denial code
Claim adjustment reason code 159. Often reported as CO 159 or PR 159.
Service resulted from terrorism
Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated .
What 159 means
The service was needed because of an act of terrorism, which the plan treats as an exclusion from coverage.
Some plans exclude care for injuries linked to acts of terrorism. This code means the payer decided the service falls under that exclusion.
Other funding sources may exist, such as government programs or victim compensation funds. Check the injury details on the claim, since an incorrect cause or indicator can lead to this code.
Group codes seen with 159
On a remittance, 159 comes after a group code. These are the ones it is most often reported with:
- CO 159 (Contractual Obligation): The provider's side of the ledger. The reduction comes from the payer contract or a rule the provider has to follow, and the patient normally cannot be billed for it.
- PR 159 (Patient Responsibility): The amount is assigned to the patient. Deductibles, coinsurance and copays are the everyday examples. Whether you can collect it still depends on your contract and the patient's plan.
The payer chooses the group code for each adjustment, so the same reason code can appear with another group code on your remittance. Read the two together. More about group codes.
Common causes
- The injury was caused by an event the payer considers an act of terrorism.
- The accident and injury details on the claim pointed to the exclusion.
- The plan has a terrorism exclusion that applies to this service.
What to do next
- Confirm the cause of the injury with the patient and the record.
- Check for other funding sources, such as public programs set up for the event.
- Correct and resubmit if the injury details on the claim were wrong.
Related codes
- 157 (reason code) Service resulted from an act of war
- 160 (reason code) Injury from an excluded activity
Source
Official wording: X12 Claim Adjustment Reason Codes list. The explanation on this page is our own plain-English wording, not the X12 text.
Last checked . Spotted a problem? Report a correction.