Remark code N178 indicates that the claim has been processed but cannot be finalized because it lacks the necessary pre-operative images or visual field results. To address this issue and facilitate payment, the healthcare provider must submit the missing documentation.
Common causes of code N178 are incomplete submission of required documentation prior to a surgical procedure, failure to include pre-operative imaging such as MRI, CT scans, or X-rays, and the absence of visual field test results when they are a necessary part of the pre-operative assessment for certain eye surgeries. Additionally, this code may be used if the documentation provided is not legible or does not meet the payer's specific criteria for pre-operative imaging or visual field results.
Ways to mitigate code N178 include implementing a comprehensive pre-operative checklist that includes a requirement for all necessary imaging and visual field results. Ensure that staff are trained to verify that these documents are in the patient's file before surgery is scheduled. Utilize electronic health record (EHR) systems with prompts or alerts that flag missing documentation for procedures that require pre-operative images or visual field results. Establish a protocol for regular communication between the surgical team, imaging department, and referring physicians to confirm that all pre-operative documentation is complete and accessible well in advance of the procedure date. Conduct periodic audits to ensure adherence to these protocols and identify areas for improvement.
The steps to address code N178 involve a multi-faceted approach to ensure that the required pre-operative images or visual field results are provided to the payer. First, review the patient's medical records to confirm whether the pre-operative images or visual field results were indeed taken and simply not submitted with the original claim. If the documentation is available, resubmit the claim with the necessary attachments.
If the documentation is missing, coordinate with the healthcare provider's office to obtain the required pre-operative images or visual field results. This may involve scheduling the patient for the necessary tests or locating existing results that were not properly filed or recorded.
Once the images or results are secured, attach them to the claim with a cover letter explaining that the previously missing information is now included. Ensure that all submissions adhere to the payer's guidelines for electronic or paper claims.
Additionally, implement a process within the practice to routinely check for the presence of required pre-operative documentation before submitting claims. This proactive measure can help prevent future occurrences of code N178 and streamline the revenue cycle management process.