RARC M76
Diagnosis missing or invalid
The diagnosis or condition on the claim is absent, incomplete or not valid as submitted.
Why you actually get this
- A diagnosis was omitted.
- An unspecified code was used where the payer requires specificity.
- A retired diagnosis code.
How to check whether it’s correct
- 01Confirm the diagnosis is present, current and as specific as the record supports.
- 02Check whether the payer requires a more specific code for this service.
Usually worth appealing
Correctable. A pattern of unspecified diagnoses is a documentation habit worth raising with the clinicians rather than fixing claim by claim.
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.