OA-240: Diagnosis Inconsistent with Birth Weight

What Does OA-240 Mean?

OA-240 is used in complex neonatal scenarios, such as when the birth weight inconsistency involves documentation from multiple facilities (e.g., birth at one facility with immediate transfer to a NICU at another).

CARC 240 is a clinical coding edit specific to neonatal claims. The payer's system has detected that the diagnosis code assigned to the patient does not align with the birth weight recorded on the claim. ICD-10 includes specific diagnosis codes for different birth weight categories (extremely low birth weight, very low birth weight, low birth weight, normal birth weight), and the payer cross-references these diagnosis codes against the actual birth weight value on the claim.

This mismatch can occur in two directions: the birth weight field on the claim may contain an incorrect value, or the diagnosis code may reference the wrong birth weight category. In either case, the claim cannot be processed until the inconsistency is resolved. This is a data integrity check designed to prevent incorrect DRG assignments and payment calculations for neonatal claims, where birth weight is a critical factor in determining the appropriate payment level.

CARC 240 typically appears with CO (contractual obligation) and usually references the 835 Healthcare Policy Identification Segment for details. Resolution is almost always a matter of correcting the coding and resubmitting — either update the birth weight field or change the diagnosis code to match the actual clinical documentation.

How to Resolve

Compare the claim's birth weight field against the medical record and diagnosis codes, correct any inconsistencies, and resubmit.

1. Obtain birth facility records If the patient was transferred, contact the birth facility to obtain the documented birth weight and compare it against your claim.
2. Reconcile and resubmit Update the claim with the correct birth weight from the birth facility's records and ensure the diagnosis code matches.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-240:

How to Prevent OA-240

• Obtain verified birth weight documentation from the birth facility before submitting claims for transferred neonates
• Establish communication protocols with referring birth facilities for timely exchange of birth records

Also Filed As

The same CARC 240 may appear with different Group Codes:

Related Denial Codes