Pathology During Hospital Stay - JE Part B
Pathology During Hospital Stay
| CARC/RARC | Description |
|---|---|
| CO-97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| M97 | Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility. |
Common Reasons for Message
- The Global and Technical components of pathology services cannot be separately billed if the patient is under the care of a hospital for the date of service.
Next Step
- Verify the Pathology service was billed correctly and includes appropriate modifiers.
- A reopening can be performed to update appropriate modifiers and place of service
- Patients’ inpatient hospital records can be verified using the Noridian Medicare Portal (NMP)
- Patients’ outpatient hospital records can be verified with the referring/ordering provider.
- If the ordering/referring provider received payment with a none-hospital place of service code on the same date of service as the pathology service, and the patient was in an outpatient hospital, the pathology service can be resubmitted.
- Submit an Appeal request - Items or services with this message have appeal rights
- Submit documentation with Redetermination request. View Medical Documentation Requirements
Claim Submission Tips
- Work with the referring/ordering provider to verify the patient’s setting
- Refer to CMS Change Request (CR) 8399 for further details.
Last Updated Oct 24 , 2024
