Remark code M8 indicates that the claim has been denied because the payer does not accept blood gas test results if the test was performed by a medical supplier or while the patient was receiving oxygen therapy. This suggests that for reimbursement, the test must be conducted under specific conditions that were not met in this instance.
Common causes of code M8 are:
1. The blood gas test was performed by a supplier that is not recognized as a certified laboratory or does not have the appropriate credentials to conduct the test.
2. The blood gas test was administered while the patient was receiving supplemental oxygen, which can alter the results and is not considered a standard condition for testing.
3. There may be a lack of proper documentation indicating that the blood gas test was performed under appropriate conditions, leading to the rejection of the test results.
4. The claim may have been submitted without the necessary modifiers or with incorrect modifiers that indicate the circumstances under which the blood gas test was performed.
5. The healthcare provider may not have followed the specific payer's policy regarding the acceptable conditions for conducting a blood gas test, resulting in the denial of the claim.
Ways to mitigate code M8 include ensuring that blood gas tests are conducted by an appropriate healthcare provider, such as a certified laboratory technician or a respiratory therapist, rather than a medical supplier. Additionally, it is important to perform the test when the patient is not receiving supplemental oxygen, unless the oxygen flow is a chronic requirement for the patient and is documented as such. Proper documentation should be maintained to reflect the setting and conditions under which the blood gas test was performed to support the medical necessity of the test and to validate the accuracy of the results. Training staff on these requirements and conducting periodic audits of blood gas test claims can help prevent this denial code from occurring.
The steps to address code M8 involve verifying the source and conditions under which the blood gas test was conducted. First, review the patient's medical records to confirm the test was not performed by a medical supplier or while the patient was on oxygen. If the test was incorrectly billed, correct the claim by providing documentation that the test was conducted by an eligible provider and under appropriate conditions. If the claim was accurately denied, consider repeating the test without the disqualifying factors. Once the necessary corrections are made or additional information is gathered, resubmit the claim with a detailed cover letter explaining the corrections or the new test results.