N86Remark Code (RARC)Active
N86 Remark Code - Coverage Requirement for Biofeedback
The N86 remark code indicates that a failed trial of pelvic muscle exercise training is a prerequisite for coverage of biofeedback training aimed at treating urinary incontinence. This means the payer is not covering the biofeedback training because the required trial has not been documented or completed.
How It Relates to the Denial
The N86 remark code typically accompanies a claim adjustment reason code that indicates a denial related to a lack of medical necessity or coverage criteria. Together, they signal that the service was not covered due to the absence of the required preceding treatment.
Common Scenarios
1A claim was submitted for biofeedback training for a patient with urinary incontinence, but the payer returned it with a denial indicating lack of medical necessity.
→ The N86 remark code clarifies that the denial is due to the absence of documentation showing a failed trial of pelvic muscle exercise training, which is necessary for coverage.
2A provider billed for biofeedback training without having performed the required pelvic muscle exercise training trial, leading to a denial from the payer.
→ In this case, the N86 remark code informs the biller that the biofeedback training is not covered because the required trial has not been conducted.
3After a patient's biofeedback claim is denied, the remittance indicates that further information is needed due to the N86 remark.
→ This remark points out that the claim could be reconsidered if evidence of a failed pelvic muscle exercise training trial is provided.
What to Do
- Obtain documentation of the pelvic muscle exercise training trial.
- Ensure that the trial was attempted and that the results are clearly documented.
- Consider resubmitting the claim for biofeedback training with the required trial evidence attached.
What to Check
- Review the patient's medical record for notes on pelvic muscle exercise training.
- Check the claim submission for any missing documentation related to the trial.
- Verify the payer's coverage policy to confirm the requirement for the trial exercise training.