N214Remark Code (RARC)Active
N214 Remark Code - Surgical History Issues
The N214 remark code indicates that there is a missing, incomplete, or invalid history concerning the initial surgical procedure(s) related to the claim. This remark supplements a Claim Adjustment Reason Code, providing additional context for why the claim may have been adjusted or denied based on the surgical history requirements.
How It Relates to the Denial
Typically, the N214 remark code accompanies adjustment reason codes that relate to surgical procedures. When seen together, they signal that the claim's adjustment is due to insufficient information about the patient's prior surgical history, which may be critical for determining coverage or medical necessity.
Common Scenarios
1A provider bills for a follow-up procedure after a recent surgery but receives a denial indicating insufficient surgical history. The remittance includes the N214 remark code.
→ In this case, the N214 remark suggests that the payer requires more detailed information about the initial surgical procedure to process the claim correctly.
2A claim for a surgical procedure is submitted, but the remittance advice shows an adjustment with a reason code related to medical necessity, accompanied by the N214 remark.
→ Here, the N214 remark indicates that the payer found the surgical history insufficient to support the medical necessity of the procedure, suggesting a need for more documentation.
3A patient undergoes a complex surgical procedure, and the claim is submitted without adequate documentation of previous surgeries. The remittance returns with an adjustment and the N214 remark code.
→ The presence of the N214 remark indicates that the payer is highlighting the lack of sufficient surgical history, which is essential for justifying the claim.
What to Do
- Gather the complete surgical history for the patient, including details of the initial procedure(s).
- Submit any missing documentation that confirms the surgical history related to the claim.
- Ensure that all relevant medical records are included when resubmitting the claim.
What to Check
- The patient's medical records to verify the history of the initial surgical procedure(s).
- The claim submission to ensure that all necessary surgical history was included.
- The payer's guidelines regarding documentation requirements for surgical procedures.