Remark code N63 indicates that the services need to be rebilled on separate claim lines. This means that if multiple services were initially billed together on a single claim line, they should be itemized and resubmitted on individual lines for each service to facilitate proper processing and payment by the payer.
Common causes of code N63 are:
1. Multiple services that should have been billed on separate claim lines were instead billed on the same line, causing confusion in the processing of the claim.
2. The use of incorrect procedure codes that may have led to services being grouped together incorrectly on the claim form.
3. The billing of bundled services without following the payer's specific billing guidelines, which may require itemization on separate lines.
4. Failure to adhere to the National Correct Coding Initiative (NCCI) edits or other payer-specific edits that dictate how certain services should be reported.
5. Inadvertent billing errors where services that are normally billed separately were combined on a single claim line due to clerical oversight or misunderstanding of billing requirements.
6. Lack of clarity in the medical documentation that accompanies the claim, leading to improper interpretation and coding of the services provided.
7. Misinterpretation of the payer's billing rules, resulting in the submission of services on a single claim line when they should have been itemized.
8. Systematic billing software issues that may automatically consolidate services onto a single line instead of separating them as required by the payer.
Ways to mitigate code N63 include ensuring that each service or procedure is billed on a separate claim line. This can be achieved by reviewing the billing format and guidelines for the specific payer to understand their requirements for claim line itemization. Implementing a robust charge capture system that automatically segregates services into distinct claim lines can also help. Additionally, providing thorough training to billing staff on the importance of individual claim line entry for distinct services will minimize the occurrence of this code. Regular audits of claim submissions can further ensure compliance with payer-specific billing practices, catching any potential errors before claims are submitted.
The steps to address code N63 involve reviewing the claim to identify the services that were bundled incorrectly. Each service should then be separated and itemized on individual claim lines. Ensure that the correct procedure codes, modifiers, and units of service are applied to each line to reflect the distinct services provided. After reorganizing the claim, resubmit it to the payer for processing. It's also advisable to audit your claim submission process to prevent similar issues in future billings.