CO-261Contractual ObligationCoding
CO-261 Denial Code: Procedure inconsistent with patient history
The service conflicts with the patient's claims history — e.g., services impossible after a prior procedure (appendectomy after appendectomy).
Why CO-261 happens
- ●History-based edits (prior surgeries, once-per-lifetime services)
- ●Payer history containing another patient's claims (identity mix)
How to fix a CO-261 denial
- 1
Verify what history triggered the edit; appeal with operative documentation if the history is wrong
How to prevent it
Screen once-per-lifetime services against patient-reported surgical history.
Drowning in CO-261 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.