M12Remark Code (RARC)Active
M12 Remark Code - Diagnostic Test Service Inclusion
The M12 remark code indicates that when a physician performs diagnostic tests, the claim must clarify whether any purchased services are included. This remark supplements a Claim Adjustment Reason Code by specifying expectations regarding the documentation of purchased services in relation to diagnostic tests.
How It Relates to the Denial
The M12 remark code typically accompanies adjustment reason codes that pertain to the inclusion or exclusion of services on a claim. This combination signals that there may be a lack of clarity regarding which services were rendered directly by the provider versus those that were purchased from another entity.
Common Scenarios
1A physician submitted a claim for diagnostic tests, but the payer returned an adjustment indicating that the claim did not specify whether any outsourced services were included.
→ The M12 remark suggests that the claim should have clearly indicated if any purchased services were part of the diagnostic tests performed, leading to the adjustment.
2A lab billed for both in-house tests and tests that were sent out for processing, but the remittance showed a denial for lack of clarity on services included.
→ The appearance of the M12 remark indicates that the claim should have specified the relationship between the in-house and purchased services, which may have contributed to the denial.
3A hospital submitted a claim that included various diagnostic tests, but the remittance advised that the claim lacked information on purchased services.
→ The M12 remark highlights the need for the hospital to clarify the inclusion of any purchased services related to the diagnostic tests to avoid confusion and potential denial.
What to Do
- Review the claim submission to ensure that it clearly indicates whether purchased services are included with the diagnostic tests.
- If necessary, revise the claim to provide additional details about any outsourced services associated with the tests performed.
What to Check
- The original claim documentation to confirm the inclusion of purchased services.
- Any notes or comments from the physician regarding the tests performed and their relationship to purchased services.
- The payer's guidelines on documentation requirements for diagnostic tests and purchased services.