Denial code M65

Remark code M65 indicates only one interpreting physician charge per claim is allowed for purchased diagnostic tests; separate claims are needed for each physician.

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What is Denial Code M65

Remark code M65 indicates that only one charge for an interpreting physician can be included on a claim when the claim is for a purchased diagnostic test. If there are multiple interpreting physicians involved, each must submit their charge on a separate claim.

Common Causes of RARC M65

Common causes of code M65 are typically related to billing errors where multiple interpreting physician charges are included on a single claim for purchased diagnostic tests. This can occur when the billing process does not properly separate the professional component (interpretation) from the technical component (actual test) of the service provided. Additionally, it may result from a misunderstanding of billing guidelines that require each interpreting physician's services to be billed on separate claims when multiple physicians interpret tests for a single patient encounter. Incorrect use of modifiers or failure to use them when necessary can also lead to this code being generated. Lastly, it could be a result of clerical errors during the claim submission process, such as inputting the wrong service date or provider information for the interpreting physician.

Ways to Mitigate Denial Code M65

Ways to mitigate code M65 include ensuring that only one interpreting physician's charge is included per claim when billing for purchased diagnostic tests. It's important to review the claim before submission to verify that it contains a single charge for interpretation. If multiple interpreting physicians are involved, separate claims should be prepared for each physician to avoid this denial code. Additionally, implementing a robust claim scrubbing process that checks for this specific issue can help catch any errors before the claim is submitted to the payer. Training billing staff on the correct way to bill for interpreting physician services in the context of purchased diagnostic tests can also reduce the likelihood of receiving code M65.

How to Address Denial Code M65

The steps to address code M65 involve reviewing the claim to ensure that only one interpreting physician's charge is included per claim when a purchased diagnostic test is indicated. If multiple interpreting physician charges are present on the same claim, they should be separated and resubmitted on individual claims. Each claim should correspond to a single interpreting physician to comply with the billing guidelines. After making the necessary adjustments, resubmit the claims for processing. It's also important to verify that the documentation supports the service billed and that the claim accurately reflects the purchased diagnostic test and the associated interpreting physician charge.

CARCs Associated to RARC M65

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