by Jared Staheli
June 29th, 2015
If high risk factors are not present, and the screening Pap smear and/or screening pelvic examination is being denied because the procedure/examination is performed more frequently than allowed, use existing ANSI X12N 835:
• Claim adjustment reason code 119 - “Benefit maximum for this time period has been reached” at the line level, and
• Remark code M83 - “Service is not covered unless the patient is classified as at high risk: at the line item level.