155Denial Code (CARC)Active
Denial Code PR 155 - Patient Refused Service
Code 155 indicates that the patient refused the service or procedure in question. This adjustment appears on the remittance when the payer processes the claim but notes that the patient did not consent to the treatment.
Who Pays: Group Code Liability
For code 155, the group code PR typically applies, meaning the patient is responsible for the charge. The provider can bill the patient since they refused the service.
Why Claims Get Code 155
- The patient verbally declined the procedure at the time of service.
- The patient revoked consent after initially agreeing to the procedure.
- There was a misunderstanding between the patient and provider about the necessity of the service.
- Documentation does not support that the patient consented to the service.
- The patient refused the service due to a change in personal circumstances or preferences.
How to Fix & Resubmit
- Verify with the provider's office that the patient indeed refused the service.
- Check the patient's medical record for any documentation of consent or refusal.
- Contact the patient to confirm their refusal and the reasons behind it.
- Update the patient's file to accurately reflect their consent status.
- If the patient agrees to proceed with the service, obtain new consent and resubmit the claim.
Corrected Claim or Appeal?
For code 155, a corrected claim is not applicable unless the patient now consents to the service. An appeal is unnecessary as the denial is based on patient refusal.
Preventing Future 155 Denials
- Ensure clear communication with patients regarding the services they consent to.
- Document patient consent or refusal thoroughly in their medical record.
- Implement a consent verification step prior to service delivery.
- Educate staff on the importance of confirming patient agreement before proceeding.