Remark code N122 indicates that the submitted claim includes an add-on procedure code that is not billable independently. Add-on codes are intended to be billed in conjunction with a primary procedure and cannot be reimbursed as standalone services. To correct this, the provider must ensure that the primary procedure code is included on the claim.
Common causes of code N122 are:
1. The primary procedure code, which the add-on code is meant to supplement, was not included on the claim.
2. The add-on code was mistakenly billed as a standalone procedure rather than in conjunction with the base code.
3. Incorrect sequencing of procedure codes on the claim, with the add-on code listed before the primary procedure code.
4. The claim was submitted without the appropriate modifiers that indicate the add-on code is related to a primary procedure.
5. The add-on code was used for a service that is not approved to be billed in conjunction with the primary procedure code by the payer's guidelines.
6. The electronic claim form may have been formatted incorrectly, causing the primary code to be overlooked or omitted during processing.
7. There may have been an error in the billing system or software that resulted in the add-on code being incorrectly flagged as a standalone service.
Ways to mitigate code N122 include ensuring that add-on codes are always billed in conjunction with their primary procedure codes. It's important to verify that the primary procedure is eligible for an add-on and that the add-on code is appropriate for the services provided. Staff should be trained to recognize which codes are designated as add-on codes and to check that they are not submitted as standalone services. Implementing a billing system that automatically flags add-on codes billed without their corresponding primary codes can also help prevent this issue. Regular audits of billing practices can identify and correct any patterns of incorrect add-on code usage before claims are submitted.
The steps to address code N122 involve reviewing the patient's billing record to ensure that the primary procedure code, which the add-on code is meant to supplement, has been included. If the primary code is missing, it should be added and the claim resubmitted. If the primary code is present and the claim was still rejected, verify that the add-on code is appropriate for the primary procedure and that it has been entered correctly. It may also be necessary to check for any updates to coding guidelines that could affect the use of the add-on code. If all information is accurate and up-to-date, contact the payer for clarification and guidance on the rejection. Once any issues are resolved, resubmit the claim with the correct coding.