Medicare Remittance Advice and solution - Part 2 (Denials and Solutions)


M76
Missing/incomplete/invalid diagnosis or condition.

Check the Dx and resubmit with corrected Dx.


M77
Missing/incomplete/invalid place of service.

Check the CPT copatability with POS and change either CPT or POS.


M79
Missing/incomplete/invalid charge.

Check the CPT


M80
Not covered when performed during the same session/date as a previously processed service for the patient.

Some of the procedure cant repeatedly perform so check the procedure.


M81
You are required to code to the highest level of specificity.



M82
Service is not covered when patient is under age 50.

Check procedure and change it accordingly.


M83
Service is not covered unless the patient is classified as at high risk.



M84
Medical code sets used must be the codes in effect at the time of service



M85
Subjected to review of physician evaluation and management services.


M86
Service denied because payment already made for same/similar procedure within set time frame.

Check the procedure and resubmit with correct Modifier.


M87
Claim/service(s) subjected to CFO-CAP prepayment review.


M89
Not covered more than once under age 40.

This procedure cant perform more than one time, bill the patient if you have ABN.


M90
Not covered more than once in a 12 month period.
Again this procedure can bill only once in a year. If you billed again Medicare will be denied as mentioned above. Bill the patient if you have ABN.

Links are simillar denials and solutions



http://billingatchennai.blogspot.com/2009/06/denial-and-actions-co-b16.html
http://billingatchennai.blogspot.com/2009/02/medicare-remittance-review-part-4.html
http://billingatchennai.blogspot.com/2009/02/medicare-remittance-advice-part-3.html
http://billingatchennai.blogspot.com/2008/10/denials-and-action-lacks-of-information.html
http://billingatchennai.blogspot.com/2008/09/medicare-denial-and-action-enrolled-in.html













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