CARC 231: Mutually exclusive procedures cannot be done in the same day/setting
Two procedures that can't clinically be performed together on the same day were billed together.
What this means for your claim
Correct Coding Initiative (CCI) edits flag procedure pairs that are considered mutually exclusive. When both appear for the same date, one is denied as part of the edit.
What to do next
- 1
Ask your provider whether the two procedures were genuinely separate and distinct (different sites or sessions).
- 2
If they were distinct, an appropriate modifier (such as -59 or an X-modifier) plus documentation may allow separate payment.
- 3
Request the provider review the CCI edit and resubmit with proper coding if a billing error occurred.
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