RARC M51
Procedure code missing or invalid
The procedure code on the claim is absent, incomplete or not valid as submitted.
Why you actually get this
- A code was omitted or truncated.
- A retired code was used.
- A character error in the code.
How to check whether it’s correct
- 01Verify the code against the current code set and the date of service.
- 02Check for truncation introduced in the submission file.
Usually worth appealing
A correction rather than an appeal. Recurring instances point at a stale code set or a template.
Often arrives with
Seeing a lot of these?
A single denial is a claim to work. A pattern of the same denial is a process to fix, and the two need completely different responses. A free panel reads ninety days of your claims data and shows which codes actually recur for you.
Remittance Advice Remark Codes are External Code List 411, maintained by CMS and published by X12. The official description of this code is theirs and is not reproduced here. Check the authoritative list for current wording and status.