CO 249 denial code
Claim adjustment reason code 249. Often reported as CO 249.
Claim flagged as a readmission
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 249 means
The payer has flagged this stay as a readmission and adjusted payment, with the provider bearing the reduction.
The patient came back to the hospital within the payer's readmission window, and the payer treats the two stays as related. It may combine them, deny the second, or reduce payment.
It is used only with group code CO, so the facility normally absorbs the adjustment. Planned readmissions and unrelated conditions are the usual grounds for appeal.
Group codes seen with 249
On a remittance, 249 comes after a group code. These are the ones it is most often reported with:
- CO 249 (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.
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 patient was readmitted shortly after discharge for a related condition.
- The payer's policy treats any return within the window as a readmission.
- A planned readmission was not identified as planned on the claim.
What to do next
- Compare the diagnoses and reasons for both stays.
- Appeal with records if the readmission was planned or clinically unrelated.
- Check whether the claim needed a code or condition code showing a planned return.
- Share readmission denials with care management to support discharge planning.
Related codes
- 216 (reason code) Based on a review organization's findings
- 232 (reason code) Institutional transfer amount
- 50 (reason code) Not medically necessary per the payer
Source
Official wording: X12 Claim Adjustment Reason Codes list. The explanation on this page is our own plain-English wording, not the X12 text.
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