How To Fix Remark Code M12 (RARC) | Common Reasons, Next Steps & How To Avoid It
Remark Code M12 means that diagnostic tests performed by a physician must indicate whether purchased services are included on the claim. This code is used to communicate the reason for denial or adjustment of a claim related to diagnostic tests. Understanding this remark code is crucial for medical coders to ensure accurate billing and reimbursement.
1. Description
Remark Code M12 indicates that diagnostic tests performed by a physician must clearly indicate whether purchased services are included on the claim. The official description states: ‘Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.’ This requirement is essential for proper billing and reimbursement, as it ensures transparency and accuracy in the claims process.
2. Common Reasons
- Lack of documentation: One common reason for Remark Code M12 is the absence of clear documentation indicating whether purchased services are included on the claim. This can lead to claim denials or adjustments.
- Incomplete diagnostic test reports: If the diagnostic test reports do not clearly state whether purchased services are included, it can result in Remark Code M12. It is crucial for physicians to provide comprehensive and accurate reports to avoid this remark code.
- Failure to follow coding guidelines: Remark Code M12 may occur if the coding guidelines for diagnostic tests are not followed properly. It is important for medical coders to stay updated with the latest coding guidelines to avoid this issue.
3. Next Steps
- Review diagnostic test reports: Medical coders should carefully review the diagnostic test reports to ensure that they clearly indicate whether purchased services are included on the claim. If any discrepancies or missing information are identified, they should be addressed promptly.
- Communicate with physicians: In cases where the diagnostic test reports do not provide clear information, medical coders should reach out to the physicians or healthcare providers to obtain the necessary clarification. Effective communication is key to resolving this remark code.
- Ensure compliance with coding guidelines: Medical coders should stay updated with the latest coding guidelines and ensure that they are followed accurately. This includes understanding the specific requirements for documenting whether purchased services are included on the claim.
4. How To Avoid It
- Educate physicians and healthcare providers: It is important to educate physicians and healthcare providers about the specific documentation requirements for diagnostic tests. By ensuring their understanding, the likelihood of encountering Remark Code M12 can be minimized.
- Implement comprehensive reporting practices: Physicians should be encouraged to provide comprehensive and accurate reports for diagnostic tests. This includes clearly indicating whether purchased services are included on the claim.
- Regularly update coding knowledge: Medical coders should stay updated with the latest coding guidelines and attend relevant training sessions or workshops to enhance their understanding of diagnostic test coding requirements.
5. Example Cases
- Case 1: A claim for diagnostic tests is denied because the test reports do not clearly indicate whether purchased services are included on the claim. This highlights the importance of accurate documentation to avoid Remark Code M12.
- Case 2: A claim adjustment occurs due to incomplete diagnostic test reports, leading to Remark Code M12. This emphasizes the need for comprehensive reporting practices to prevent this remark code.
Source: Remittance Advice Remark Codes
