CARC 9CO · Contractual Obligation
The diagnosis code submitted doesn't match what's clinically expected for the patient's age (e.g., a pediatric-only diagnosis billed for an adult).
- Common causes
- A transcription error, an outdated diagnosis code, or the wrong patient's diagnosis was entered on the claim.
- Suggested fix
- Verify the diagnosis against the patient's chart and age, correct if needed, and resubmit with supporting documentation if the diagnosis is accurate as billed.
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 9 mean?
The diagnosis code submitted doesn't match what's clinically expected for the patient's age (e.g., a pediatric-only diagnosis billed for an adult).
How do I resolve CARC 9?
Verify the diagnosis against the patient's chart and age, correct if needed, and resubmit with supporting documentation if the diagnosis is accurate as billed.
Why does CARC 9 happen?
A transcription error, an outdated diagnosis code, or the wrong patient's diagnosis was entered on the claim.
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.