Remark code N674 is an alert that coverage is denied unless a specific prior procedure or service has been completed.
Remark code N674 indicates that the service or procedure is not covered under the patient's health plan unless a specific pre-requisite procedure or service has been provided beforehand.
Common causes of code N674 are:
1. The billed service or procedure is considered a secondary or subsequent intervention that requires documentation of a prior, specific treatment or procedure that has not been recorded or provided.
2. The pre-requisite procedure or service, as defined by the payer's policy, was not completed within the required timeframe relative to the billed service.
3. Incorrect or incomplete documentation was submitted, failing to verify that the necessary pre-requisite procedure or service was performed.
4. The claim was submitted without the appropriate linkage or reference to the pre-requisite procedure or service, leading to a lack of evidence from the payer's perspective.
5. There may have been an error in coding, where the pre-requisite procedure or service was performed but was either not coded at all or coded incorrectly.
6. The payer's guidelines for the pre-requisite procedure or service may have recently changed, and the provided service did not meet the new criteria.
Ways to mitigate code N674 include implementing a comprehensive verification process before scheduling or performing services. This involves ensuring that all prerequisite procedures or services have been completed and documented. Training staff to recognize when certain services require precursors and establishing a protocol for checking patient records for these prerequisites can also help. Additionally, integrating an automated alert system within your electronic health records (EHR) that flags when a prerequisite procedure is needed before proceeding with the planned service can prevent this issue. Regularly updating your EHR's rules to reflect current coverage requirements and conducting periodic audits to identify and rectify any gaps in prerequisite procedures can further reduce the incidence of N674.
The steps to address code N674 involve first reviewing the patient's medical records to confirm whether the prerequisite procedure or service has indeed been provided and documented appropriately. If the prerequisite service is found to have been performed, ensure that its documentation is clear, accurate, and attached to the claim. This may involve obtaining operative reports, physician notes, or other relevant documentation that clearly supports the performance of the required service prior to the one being billed.
Next, resubmit the claim with the additional documentation attached, highlighting the evidence of the prerequisite service. If the prerequisite service was not performed, evaluate the medical necessity and potential for performing the required service, if still clinically appropriate. Communicate with the healthcare provider to discuss the necessity and timing for the prerequisite service, and plan for its completion.
After the prerequisite service is provided, document it thoroughly in the patient's medical records. Then, submit a new claim for both the prerequisite service (if not previously billed) and the initially denied service, ensuring that the documentation clearly supports the sequence of services as per the payer's requirements.
If the claim is denied again despite these steps, consider reaching out directly to the payer for a more detailed explanation of the denial and guidance on what specific documentation or information is lacking. This direct communication can also serve as an opportunity to advocate for the patient's need for the service, especially if there is strong clinical justification for the sequence in which the services were provided or are being sought.
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