CARC 186CO · Contractual Obligation
Payment was adjusted to reflect a change in the patient's level of care during the stay, such as from ICU to a lower-acuity bed.
- Common causes
- The patient's care level changed partway through an inpatient stay, and reimbursement was recalculated to reflect the mix of care levels.
- Suggested fix
- Verify the level-of-care documentation and dates align with the billed room and board charges; correct and resubmit if there's a discrepancy.
Related Contractual Obligation codes
107This claim depends on another related claim or service being referenced, but that link wasn't provided.11The diagnosis code doesn't support medical necessity for the procedure billed, based on the payer's coverage edits.13The claim shows a date of service after the patient's recorded date of death.146The diagnosis code billed wasn't a valid, active code as of the date of service.150The documentation submitted doesn't justify the complexity or level of the service billed, commonly seen with evaluation and management visit levels.16The claim is missing required information or contains a billing error that prevented the payer from processing it.170This payer doesn't reimburse this specific provider type for this service.171This payer doesn't cover this service when it's billed by this provider type in this particular facility setting.
Frequently asked questions
What does CARC 186 mean?
Payment was adjusted to reflect a change in the patient's level of care during the stay, such as from ICU to a lower-acuity bed.
How do I resolve CARC 186?
Verify the level-of-care documentation and dates align with the billed room and board charges; correct and resubmit if there's a discrepancy.
Why does CARC 186 happen?
The patient's care level changed partway through an inpatient stay, and reimbursement was recalculated to reflect the mix of care levels.
CARC codes maintained by X12 (x12.org). Descriptions on this site are original reference interpretations. Always verify codes with authoritative sources before making billing decisions.