232Denial Code (CARC)Active
CO 232 Denial Code - Fix DRG Transfer Adjustments
Code 232 indicates a financial adjustment on institutional claims when a patient's care involves multiple institutions. This code specifically accounts for the difference in the Diagnosis-Related Group (DRG) amount when the patient is transferred. It reflects the recalibration of payment due to the transfer between facilities.
Who Pays: Group Code Liability
For code 232, the adjustment typically falls under the CO group code, meaning it is a contractual write-off. The patient should not be billed for this adjustment.
Why Claims Get Code 232
- Patient was transferred from one hospital to another during the course of care.
- The initial DRG payment was based on a single institution's care plan, requiring adjustment.
- Claim involved multiple facilities but was initially billed as a single-institution claim.
- The DRG rates between the involved institutions differ, necessitating a recalibration.
How to Fix & Resubmit
- Verify that the patient was indeed transferred between institutions and that the claim reflects this accurately.
- Check that the DRG payment adjustments match the expected rates for each institution involved.
- Ensure the claim was billed under the correct institutional identifiers for all involved facilities.
- If discrepancies exist, contact the payer to confirm the correct DRG rates and adjustments.
- Submit a corrected claim if the original claim data was incorrect or missing institutional transfer details.
Corrected Claim or Appeal?
For code 232, submitting a corrected claim is appropriate if the original claim data was incorrect regarding the transfer. No appeal is needed unless there is an error in the payer's adjustment logic.
Preventing Future 232 Denials
- Ensure accurate documentation of patient transfers between institutions in the medical record.
- Verify DRG coding and institutional identifiers before claim submission when multiple facilities are involved.
- Coordinate with all involved facilities to confirm accurate billing information prior to claim submission.
- Regularly update internal billing guidelines to reflect current DRG and institutional billing protocols.