Remittance Advice Notices for Colorectal Cancer Screening (Rev. 1, 10-01-03)

by  Jared Staheli
July 5th, 2015

All messages refer to ANSI X12N 835 coding.

A. If the claim for a screening fecal-occult blood test, a screening flexible sigmoidoscopy, or a screening barium enema is being denied because the patient is less than 50 years of age, use:

• Claim adjustment reason code 6 “the procedure code is inconsistent with the patient’s age,” at the line level; and

• Remark code M82 “Service is not covered when patient is under age 50.” at the line level.

B. If the claim for a screening fecal-occult blood test, a screening colonoscopy, a screening flexible sigmoidoscopy, or a screening barium enema is being denied because the time period between the test/procedure has not passed, use:

• Reason code 119 “Benefit maximum for this time period has been reached” at the line level.

C. If the claim is being denied for a screening colonoscopy (code G0105) or a screening barium enema (G0120) because the patient is not at a high risk, use:

• Claim adjustment reason code 46 “This (these) service(s) is (are) not covered” at the line level; and

• Remark code M83 “Service is not covered unless the patient is classified as a high risk.” at the line level.

D. If the service is being denied because payment has already been made for a similar procedure within the set time frame, use:

• Claim adjustment reason code 18, “Duplicate claim/service” at the line level; and

• Remark code M86 “Service is denied because payment already made for similar procedure within a set timeframe.” at the line level.

E. If the claim is being denied for a noncovered screening procedure such as G0122, use:

• Claim adjustment reason code 49, “These are noncovered services because this is a routine exam or screening procedure done in conjunction with a routine exam.”

F. If the claim is being denied because the code is invalid, use the following at the line level:

Claim adjustment reason code B18 “Payment denied because this procedure code/modifier was invalid on the date of service or claim submission.”

References:

Remittance Advice Notices for Colorectal Cancer Screening (Rev. 1, 10-01-03). (2015, July 5). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/remittance-advice-notices-for-colorectal-cancer-screening-rev-1-10-01-03-26997.html

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