CARCContractual Obligation
CARC 10: The diagnosis is inconsistent with the patient's age
The billed diagnosis doesn't match the patient's age — for example, a pediatric condition billed for an adult.
What this means for your claim
Automated claim edits flag diagnoses that are age-specific. This is often a coding error that can be corrected with a resubmission.
What to do next
- 1
Ask your provider to verify the patient's date of birth on the claim and the ICD-10 code used.
- 2
If the diagnosis is genuinely appropriate for your age despite an age-based edit, ask your provider to appeal with clinical documentation.
- 3
Check for data entry errors in the claim — a wrong birth year is a common root cause.
Have more codes on your EOB?
Upload your full Explanation of Benefits and our analyzer will identify every adjustment code, explain each one in plain English, and flag anything worth disputing.
Analyze My EOB Free →