CARC 249CO · Contractual Obligation
This inpatient stay was identified as a readmission, which may trigger different payment rules under readmission reduction programs.
- Common causes
- The patient was readmitted within a defined window, often 30 days, after a prior related discharge.
- Suggested fix
- Verify whether the readmission is clinically related to the prior stay and whether it's exempt from readmission payment adjustments; appeal if miscategorized.
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 249 mean?
This inpatient stay was identified as a readmission, which may trigger different payment rules under readmission reduction programs.
How do I resolve CARC 249?
Verify whether the readmission is clinically related to the prior stay and whether it's exempt from readmission payment adjustments; appeal if miscategorized.
Why does CARC 249 happen?
The patient was readmitted within a defined window, often 30 days, after a prior related discharge.
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.