Monday, June 20, 2011

Remark code - N357, M119, M123, M2, M50, M54 & N129, N130, N19

Denial Code 45, 50, 54,58, 59, 60, 96, 97 and related remark codes



Adj. Reason Code
Adj. Reason Code Description
Remark
Code

Remark Code Description
Exception Code Description
45 Charges exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use Group Codes PR or CO depending upon liability).
SUBMITTED CHARGE ON 340B CLAIM TOO HIGH
50 These are non-covered services because this is not deemed a `medical necessity' by the payer.
RECIPIENT DENIED NO MEDICAL NEED
54 Multiple physicians/assistants are not covered in this case.
ASSISTANT SURGEON NOT COVERED
58 Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.
RECIP DENIED INAPP PLCMNT
59 Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia).
TWO ANESTHESIA SERVICES
60 Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services.
N357
Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
INPT/OUTPT CONFLCT
PAID OUTPT CLAIM CONFLICT
60 Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services.
OUTPT/DRG CONFLICT
EMERGENCY ROOM NOT PAYABLE
EMERG ROOM OTH/SVCS NOT PAYBLE
96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
M119
Missing/incomplete/invalid/deactivated/withdrawn
National Drug Code (NDC).
DRUG DISCONTD- NO ALTERNATE
DRUG DISCONTD-BILL REPLACEMENT
96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
M123
Missing/incomplete/invalid name, strength, or dosage of the drug furnished.
COMPOUND NOT COVERED FOR PROGRAM TYPE
96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
M2
Not paid separately when the patient is an inpatient.
INPT OT IS PART OF HOSP PYMT
96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
M50
Missing/incomplete/invalid revenue code(s).
NON-COVERED MCAID REVENUE CODE
96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
M54
Missing/incomplete/invalid total charges.
INVALID TOTAL NON/COV CHARGE
96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
M67
Missing/incomplete/invalid other procedure code(s).
OTHER SURG PROC NOT COVERED
OTHER PROC NOT COVERED (81)
96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
M79
Missing/incomplete/invalid charge.
XOVR CLM - CHIROPRACTOR NOT CVRD
96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
MA66
Missing/incomplete/invalid principal procedure code.
PRINCIPAL SURG PROC NOT CVRD
96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
N129
Not eligible due to the patient's age.
CHEC RECIPIENT AGE IS GREATER THAN 20
INVAL RECIP AGE/DRUG(REF FILE)
PROC NOT PAYABLE FOR AGE OR PROV TYPE
TOOTH NOT COVERED FOR ROOT CANAL
96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
N130
Consult plan benefit documents/guidelines for information about restrictions for this service.
INPT PSYC,REHAB/SURG CNFLCT
X-OVER NOT COVERED FOR PCN
96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
N216
We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.
NONCOVERED MEDICAID BENFIT
96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).
N30
Patient ineligible for this service.
CUSTODY MEDICAL CARE CLAIMS
CLAIM/REF FILE AID TYPE CONF
EMERGENCY ONLY CLIENT NON COVERED SVC
NURSING HOME CLAIM PCN ELIGIBLE
INVALID PREGNANCY INDICATOR FOR DRUG
NDC'S IN COMPOUND NON-COVERED
97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
M14
No separate payment for an injection administered
during an office visit, and no payment for a full office visit if the patient only received an injection.
INJECTION/OFFICE CALL CONFLICT
THERAPEUTIC INJECTION/OFFICE CALL CONFLICT
97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
M86
Service denied because payment already made for same/similar procedure within set time frame.
GLOBAL/OTHER DELVRY CONFLICT
GLOBAL ALREADY PAID
TWO GLOBAL - SAME CYCLE
GLOBAL CARE PAID
SRVC INCLUDED IN GLOBAL
97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
N19
Procedure code incidental to primary procedure.
PAYMENT INCLUDED IN PRIMARY PROCEDURE
CURRENT PROC INCIDNTL OTHER CURRENT PROC
HIST PROC INCIDNTL OTHER CURRENT PROC
97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
N20
Service not payable with other service rendered on the same date.
UN-BUNDLED SERVICE VS BUNDLED SERVICE
E&M SERVICE NOT REIMBURSED SEPARATELY
97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
N390
This service/report cannot be billed separately.
INJECTION PART OF ASPIRATION
97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
ASPIRATION/INJCTN CONFLICT
SERVICE IS COVERED IN DHS DAILY RATE
BUNDLED PROCEDURE/HISTORY OF PAID CLAIM
EMER EXAM/OTHER SERV SAME DOS
PD OUTPT CLAIM CONFLICT
COG SERV IS IN PACKAGE PROC
PROC COMBINATION NOT EXPECTED SAME DAY
PROC COMBO NOT EXPTD SAME DAY,PD CLM HIS
PAYMENT INC W/ DENTAL PACKAGE PROCEDURE
PAYMENT INC W/DENTL PKG PROC,PD CLM HIST
DENTL EXAM INC W PAYMENT OF ANOTHER CODE
DENTL EXAM IN W PAYMENT OF PD CLM HIST
DENTL PROC COMBO NOT EXPECTED SAME DAY
D PROC COMBO NOT EXP SAME DAY,PD CLM HIS
CURRNT PROC MUTUAL EXCLUSV TO HISTR PROC
HIST PROC MUTUAL EXLUSV TO CURRENT PROC

N19 - Procedure code incidental to primary procedure.

Reason for denial:
Payer does not pay separately for this service
Some services/procedures are considered "always bundled". These services can never be separately reimbursed.
To confirm whether the procedure billed is considered always bundled please refer to the carrier website or NCC Edits and check to see if the procedure has a status code of "B" or "P". If so it is always considered bundled and no additional reimbursement is paid by Medicare. Based on that we can call the carrier and argue to get paid.

Actions:
Confirm that you have billed the correct procedure code.
If the wrong code was originally submitted send a new claim.
If the correct code was used, write off the charges. Do not rebill the claim or bill the beneficiary.

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