DENIAL CODES

Denial code M66

Remark code M66 indicates billing errors for tests with price limits; it advises separating technical and professional components on claims.

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What is Denial Code M66

Remark code M66 indicates that the claim submitted includes diagnostic tests with procedure codes that encompass a professional component, but according to the records, only the technical component is subject to price limitations. To resolve this issue, the provider is instructed to bill the technical and professional components as separate line items on the claim.

Common Causes of RARC M66

Common causes of code M66 are:

1. The billing of diagnostic tests was not itemized to reflect separate charges for the technical and professional components.

2. The claim was submitted with a global procedure code that includes both the technical and professional components, rather than using the appropriate modifiers to differentiate the two.

3. There may have been an oversight or misunderstanding of the billing guidelines that require the technical and professional components to be billed separately when price limitations are in place.

4. The billing software or process may not have been set up to automatically split the technical and professional components for procedures subject to price limitations.

5. The claim was submitted without the use of modifier -TC for the technical component and modifier -26 for the professional component, which are necessary to indicate the separate parts of the service.

6. The provider may not have been aware that the specific diagnostic test being billed was subject to price limitations, leading to incorrect claim submission.

Ways to Mitigate Denial Code M66

Ways to mitigate code M66 include ensuring that when billing for diagnostic tests with both professional and technical components, the components are billed on separate line items. It's important to review the Current Procedural Terminology (CPT) codes and modifiers used in the claim to verify that they accurately reflect the services provided. Utilize modifiers that specifically indicate which part of the service is being billed, such as -26 for the professional component and -TC for the technical component. Additionally, staff training on proper coding practices and regular audits of billing processes can help prevent this issue from occurring. Implementing a robust charge capture system that automatically separates professional and technical charges based on the services rendered can also be beneficial in avoiding remark code M66.

How to Address Denial Code M66

The steps to address code M66 involve reviewing the claim to ensure that the diagnostic tests with price limitations have been billed correctly. You should separate the technical and professional components of the service into distinct line items. Begin by identifying the services that were provided and verify if they have both technical and professional components. Then, adjust the billing to reflect these components separately on the claim form. Use the appropriate modifiers to indicate which part of the service is the technical component and which is the professional component. Once the claim has been corrected, resubmit it to the payer for processing. It's also advisable to check your billing system to ensure that future claims for similar services are split correctly at the outset to prevent recurring denials.

CARCs Associated to RARC M66

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