DENIAL CODES

Denial code M122

Remark code M122 indicates a claim rejection due to missing, incomplete, or invalid subluxation level documentation.

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What is Denial Code M122

Remark code M122 indicates that the claim has been flagged because it lacks the necessary information, or contains incomplete or invalid details, regarding the level of subluxation. This information is essential for certain types of treatments, such as chiropractic services, to justify the medical necessity and appropriateness of the care provided. The healthcare provider must provide the correct level of subluxation documentation in order to process the claim successfully.

Common Causes of RARC M122

Common causes of code M122 are documentation errors where the level of subluxation is not clearly indicated, incomplete patient records that fail to include the necessary chiropractic findings, or the submission of claims without the required x-ray or physical examination evidence to support the diagnosis of subluxation. Additionally, this code may be used if there is a discrepancy between the diagnosis codes and the level of subluxation documented, or if the provider has not adhered to the specific coding guidelines for reporting subluxation levels in chiropractic care.

Ways to Mitigate Denial Code M122

Ways to mitigate code M122 include ensuring that all chiropractic claims are accompanied by detailed documentation that clearly indicates the level of subluxation. This can be achieved by implementing a thorough review process where clinical notes are checked for the required information before submission. Additionally, staff training on the importance of accurate and complete documentation can help reduce instances of this code. Regular audits of chiropractic claims can also identify patterns that lead to this error, allowing for corrective action to be taken. It's essential to have a system in place that prompts the provider to include all necessary details regarding subluxation levels in the patient's record.

How to Address Denial Code M122

The steps to address code M122 involve several key actions to ensure that the claim can be processed correctly. First, review the patient's medical records to verify the presence of a documented level of subluxation. If the documentation is missing or incomplete, reach out to the healthcare provider who performed the service to obtain the necessary information or to clarify the existing documentation.

Next, ensure that the level of subluxation is accurately and clearly recorded in the patient's chart and that it aligns with the coding guidelines for specificity and detail. Update the claim with the correct and complete information regarding the level of subluxation.

Once the claim has been updated, resubmit it to the payer. Keep a record of the changes made and any communication with the healthcare provider for future reference. Monitor the claim to ensure that it is processed and follow up as necessary to address any further issues that may arise.

CARCs Associated to RARC M122

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