N98Remark Code (RARC)Active
N98 Remark Code - Patient Test Stimulation Requirement
The N98 remark code indicates that a patient must have successfully completed a test stimulation before being eligible for permanent implantation. Specifically, the patient needs to show a 50 percent or greater improvement through test stimulation, measured via voiding diaries.
How It Relates to the Denial
The N98 remark code typically accompanies adjustment reason codes related to denials for procedures like permanent implantation when the necessary pre-conditions have not been met. This combination signals that the payer is looking for documentation of the patient's improvement through test stimulation.
Common Scenarios
1A patient was billed for a permanent implantation procedure but received a denial on the remittance advice, with the N98 remark code included.
→ In this case, the N98 code suggests that the payer did not approve the procedure because the patient did not have the required successful test stimulation to justify the implantation.
2A claim for implantation was submitted, but the remittance returned with an adjustment noting insufficient documentation, accompanied by the N98 remark code.
→ The presence of the N98 remark indicates that the payer expects evidence of the patient's improvement from test stimulation, which was not provided.
3After a claim for permanent implantation was denied, the remittance included the N98 remark code along with a reason code for lack of medical necessity.
→ Here, the N98 remark clarifies that the reason for denial is tied specifically to the patient's failure to demonstrate the requisite improvement through test stimulation.
What to Do
- Obtain and submit voiding diaries that document the patient's improvement from the test stimulation.
- Ensure that any additional documentation proving the successful test stimulation is included with any resubmission.
- Verify that the claim accurately reflects the patient's eligibility based on the required criteria before resubmitting.
What to Check
- Review the patient's medical records for documentation of the test stimulation and improvement metrics.
- Check the voiding diaries to confirm the percentage of improvement achieved by the patient.
- Look at the previous claim submissions to ensure all necessary information was provided regarding the test stimulation.