Telehealth has transformed radiology, enabling remote image reviews and consults. However, evolving payer rules can lead to claim denials if documentation isn’t spot-on. Here’s a practical guide to fixing and preventing denials for radiology services, like CPT 72100 (spine X-ray, 2 views), while staying cautious to avoid costly errors.

Fixing CO-170 Denials: Incomplete Documentation

What is CO-170?

This denial code flags missing or inadequate telehealth documentation, such as patient location, consent, or technology used.

Scenario: A radiologist reviews a spine X-ray (CPT 72100) remotely but gets a CO-170 denial because the claim lacks:

• Proof the review was remote
• Patient and provider locations
• Telehealth method (e.g., video or store-and-forward)
• Patient consent

How to Fix:

Reopen the claim and add:

• Patient and provider locations (e.g., home or clinic)
• Telehealth method (e.g., “reviewed via secure store-and-forward platform”)
• Timestamps for image receipt and interpretation
• A note confirming patient consent

Sample Appeal Letter

[Your Practice Name]

[Date]

[Payer Name], Appeals Department

Re: Claim #[Insert Number]

Dear Reviewer,

We’re appealing the CO-170 denial for CPT 72100 (telehealth spine X-ray) on [Date of Service]. Updated documentation includes:

• Patient Location: [e.g., Home or Clinic]
• Provider Location: [e.g., Remote Office]
• Method: [e.g., “Images reviewed via secure store-and-forward system”]
• Consent: [e.g., “Patient consented to telehealth on [date]”]
• Service Details: “2-view spine X-ray interpreted; findings documented”

Please review and approve this claim per your telehealth guidelines.

Sincerely,

[Your Name], MD

[Contact Info]

Preventing Denials for CPT 72100

Key Tips

• Audit Regularly: Spot-check telehealth notes to ensure they’re complete.
• Train Staff: Ensure everyone records consent and key details.
• Use Templates: Customize appeal letters for quick, payer-specific submissions.
• Stay Updated: Payer rules vary—check modifier and documentation requirements often.

Takeaway

Denials for telehealth radiology claims like CPT 72100 can be avoided with clear documentation and proactive steps. Specify locations, methods, and consent, use the right modifiers, and appeal denials with detailed evidence. Staying diligent keeps reimbursements flowing and supports critical care delivery.