Remark code M79 indicates that the claim contains a charge that is missing, incomplete, or invalid. This may require the healthcare provider to review the claim and provide additional information or correct any errors related to the charge in question before resubmission.
Ways to mitigate code M79 include implementing a robust charge capture process that ensures all services provided are accurately documented and billed. This can be achieved by:
- Training staff thoroughly on proper documentation practices to ensure that all services are recorded promptly and completely.
- Utilizing electronic health records (EHR) and practice management systems that flag missing or incomplete charges before claims submission.
- Conducting regular audits of charges to identify and address any patterns of missing or invalid entries.
- Establishing clear protocols for charge entry, including the use of standardized procedure codes and descriptions that align with payer requirements.
- Integrating charge capture with clinical workflows to minimize the risk of human error and ensure that all billable services are accounted for.
- Keeping up to date with payer billing guidelines to ensure that all charges meet current standards for validity and completeness.
- Encouraging open communication between clinical and billing departments to quickly resolve any discrepancies or questions regarding charge entries.
The steps to address code M79 involve a thorough review of the billing documentation to ensure that all charges are accurately captured and properly coded. Begin by cross-referencing the service codes with the corresponding dates of service, provider information, and the services rendered. Verify that each charge has a valid Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code and that none are missing or incorrectly applied.
Next, check for any clerical errors such as typos or transposed numbers that could have led to the invalid charge notice. If the charge was indeed omitted, add the correct charge with the appropriate service code and resubmit the claim. If the charge is found to be invalid or incorrect, adjust the billing record to reflect the accurate service provided and update the claim accordingly.
Ensure that all charges are supported by the necessary documentation in the patient's medical record, including physician orders, progress notes, and operative reports if applicable. This documentation should justify the services billed and demonstrate their medical necessity.
Once all corrections are made, resubmit the claim with the revised charges and include any additional documentation requested or required to support the validity of the charges. Keep a record of the changes made and monitor the claim to ensure that it is processed correctly upon resubmission. If the issue persists, consider additional training for staff on proper charge capture and coding practices to prevent future occurrences of code M79.