N459Remark Code (RARC)Active
N459 Remark Code - Missing Discharge Summary Explained
The N459 remark code indicates that a discharge summary is missing from the claim submitted for payment. This remark supplements an adjustment already noted by an associated Claim Adjustment Reason Code, providing additional context for the denial or reduction in payment.
How It Relates to the Denial
The N459 remark typically accompanies adjustment reason codes that relate to missing documentation or incomplete medical records. The combination of these codes signals that the claim cannot be processed fully due to the absence of the required discharge summary.
Common Scenarios
1A hospital submits a claim for inpatient services provided to a patient, but the remittance advises that payment has been adjusted due to missing documentation.
→ The N459 remark indicates that the payer is specifically looking for a discharge summary to support the claim, which is necessary for processing.
2A skilled nursing facility bills for a patient's stay but receives a denial indicating that certain documentation is lacking.
→ In this case, the N459 remark suggests that the payer requires the discharge summary to validate the services rendered before considering payment.
3A physician's office files a claim for post-discharge follow-up services, and the remittance shows an adjustment with N459 noted.
→ The remark N459 points to the need for a discharge summary that outlines the patient's condition and treatment at discharge, which is essential for the claim's approval.
What to Do
- Obtain the missing discharge summary from the medical record.
- Submit the discharge summary along with any required documentation to support the claim.
- Ensure that all relevant details are included in the discharge summary to meet payer requirements.
What to Check
- The patient's medical record for the discharge summary.
- The original claim submission for any missing attachments.
- The remittance advice for any associated adjustment reason codes that clarify payment adjustments.