M45Remark Code (RARC)Active
M45 Remark Code - Missing/Invalid Occurrence Codes
The M45 remark code indicates that there are missing, incomplete, or invalid occurrence code(s) associated with the claim. This remark supplements the primary Claim Adjustment Reason Code by providing additional context about the specific issue with the occurrence codes.
How It Relates to the Denial
The M45 remark code typically appears alongside adjustment reason codes that indicate a claim was denied or adjusted due to issues with the occurrence codes. The combination signals that the claim cannot be processed accurately without proper occurrence code information.
Common Scenarios
1A claim for a surgical procedure was submitted, but the remittance shows the M45 remark code in response to the adjustment reason code indicating a denial for incomplete information.
→ In this scenario, the M45 remark code highlights that the claim is missing necessary occurrence codes, which are needed to support the services billed.
2A physical therapy claim was denied with a reason code related to a lack of documentation, and the M45 remark code was also included, indicating issues with occurrence codes.
→ The presence of the M45 remark code suggests that, in addition to the documentation issue, there are also problems with the occurrence codes that need to be addressed before resubmission.
3An outpatient claim was partially paid, and the remittance includes an adjustment reason code for underpayment with the M45 remark code attached.
→ The M45 remark code indicates that the underpayment may be tied to missing or invalid occurrence codes, which could affect the total reimbursement amount.
What to Do
- Review the occurrence codes submitted on the claim to ensure they are complete and valid.
- Correct any errors found in the occurrence codes and resubmit the claim with the necessary adjustments.
- If additional documentation is required to support the occurrence codes, prepare that documentation for resubmission.
What to Check
- The claim submission details to verify the occurrence codes used.
- The payer's guidelines for valid occurrence codes relevant to the services billed.
- Any prior communications or documentation requests from the payer related to the occurrence codes.