DENIAL CODES

Denial code M85

Remark code M85 indicates a review of physician evaluation and management services for billing accuracy.

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What is Denial Code M85

Remark code M85 indicates that the claim has been subjected to a review of physician evaluation and management services. This means that the billing for these services has undergone additional scrutiny to ensure that the charges align with the provided level of care, documentation, and applicable coding standards.

Common Causes of RARC M85

Common causes of code M85 are discrepancies or inconsistencies in the documentation of physician evaluation and management (E/M) services. This may include insufficient detail in the patient's medical record to support the level of service billed, missing or incomplete history and physical examination notes, or a lack of medical necessity for the services provided. Additionally, this code may be triggered if the coding of the E/M service does not align with the provider's specialty or if there is a mismatch between the diagnosis codes and the E/M service level. Audits and reviews may also uncover instances where the frequency of services exceeds the standard practice, raising questions about the appropriateness of the care delivered.

Ways to Mitigate Denial Code M85

Ways to mitigate code M85 include ensuring that the documentation for physician evaluation and management (E&M) services is comprehensive and accurately reflects the level of service provided. Providers should regularly train staff on current coding guidelines and documentation requirements for E&M services. Implementing a robust internal auditing process to review E&M services before claims submission can help identify and correct any discrepancies. Additionally, utilizing electronic health record (EHR) systems with built-in coding tools and alerts can assist in selecting the appropriate level of service codes based on the documented elements of the encounter. It's also beneficial to stay updated on any changes in coding standards and payer-specific guidelines related to E&M services to prevent this code from being triggered.

How to Address Denial Code M85

The steps to address code M85 involve a thorough review of the documentation for the physician evaluation and management (E&M) services billed. Ensure that the patient's medical records accurately reflect the level of service provided and that the documentation meets the necessary criteria for the E&M codes claimed. If discrepancies are found, correct the coding on the claim and resubmit it. If the documentation supports the original codes billed, prepare and submit a detailed written appeal to the payer, including all relevant medical records and a clear explanation of why the services were medically necessary and appropriately billed. Additionally, consider conducting an internal audit of E&M coding practices to identify any patterns that could lead to this remark code and implement staff training or process improvements as needed to prevent future occurrences.

CARCs Associated to RARC M85

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