Remark code N20 indicates that the service billed is not payable when it is performed in conjunction with another service that was rendered on the same date. This could mean that the payer considers the service to be included as part of the comprehensive service provided on that day, or that there is a billing error where services that should not be billed together were submitted simultaneously. It is important to review the coding and billing practices to ensure compliance with payer guidelines and to determine if a separate claim or an appeal is necessary.
Common causes of code N20 are:
1. The billed service is considered part of another service or procedure that has already been billed and paid for the same date of service.
2. There is an overlap in the billing where two services provided on the same date are not compatible or allowed together according to payer guidelines.
3. The service may be bundled into another comprehensive code, making it non-payable as a separate fee.
4. Incorrect coding or modifier usage may have led to the denial, indicating that the services are considered inclusive when they should be billed separately.
5. The payer's policy may have specific rules about which services can be billed on the same day, and the submitted service does not meet those criteria.
6. There may be a lack of necessary documentation to justify the medical necessity of both services on the same date, resulting in the denial of one of the services.
Ways to mitigate code N20 include carefully reviewing the payer's bundling policies to understand which services are not separately reimbursable when performed on the same day. Ensure that coding practices align with these policies by using appropriate modifiers when applicable and justified by the clinical scenario. Additionally, implement a robust pre-claim review process to catch potential conflicts between services scheduled or performed concurrently, and provide ongoing education to billing and coding staff about the correct coding combinations to avoid this denial. Regularly audit claims to identify patterns that may lead to N20 denials and adjust practices accordingly.
The steps to address code N20 involve a thorough review of the patient's billing record for the date of service in question. First, identify the services billed and determine if they are typically bundled or if one service is inclusive of the other. If the services are correctly unbundled, gather supporting documentation that justifies the medical necessity for each service being billed separately. This may include detailed notes from the provider, operative reports, or any other relevant clinical documentation.
Next, review the payer's guidelines to ensure that the services rendered align with their billing policies. If the services were incorrectly billed together, adjust the claim to remove the service that is not payable or to correct the billing codes as necessary.
If you believe the services were correctly billed and should be paid separately, prepare and submit a written appeal to the insurance payer. Include a clear explanation, supported by clinical documentation, as to why both services were necessary and should not be bundled. Ensure that the appeal is submitted within the payer's specified timeframe for appeals.
In the meantime, communicate with the provider or clinical team to verify that the services provided were distinct and necessary. This will help prevent similar issues in future billing cycles. Additionally, consider implementing a proactive auditing process to catch these types of errors before claims are submitted, which can help reduce denials and improve revenue cycle efficiency.