173Denial Code (CARC)Active
CO 173 Denial Code - Fix Missing Physician Order
CARC 173 means the payer denied the claim because the service or equipment was not prescribed by a physician. This adjustment indicates that the payer requires a physician's order to cover the item or service billed.
Who Pays: Group Code Liability
For CARC 173, liability generally falls under the CO group code, meaning the adjustment is typically a contractual write-off and the patient cannot be billed. However, if the payer's policy allows, it might be assigned to PR, making it the patient's responsibility.
Why Claims Get Code 173
- The service was billed without an accompanying physician's order.
- The physician's order was not submitted with the claim.
- The order submitted did not match the billed service or equipment.
- The prescribing physician is not in network or not eligible to prescribe the service.
- The order was dated after the service was provided.
How to Fix & Resubmit
- Verify if a physician's order exists for the service or equipment.
- Ensure the order is signed and dated prior to the service date.
- Check if the prescribing physician is in network and eligible to prescribe.
- Submit the physician's order with a corrected claim if not initially included.
- Contact the payer for guidance if the order was submitted but still denied.
Corrected Claim or Appeal?
Submit a corrected claim with the necessary physician's order if it was missing. If the order was submitted and the denial persists, consider appealing with documentation proving the order's validity.
Preventing Future 173 Denials
- Ensure all services and equipment have a valid physician's order before billing.
- Implement a checklist to confirm physician orders are attached to claims.
- Verify the eligibility of physicians to prescribe specific services in advance.
- Train staff on payer-specific documentation requirements for prescriptions.