Pathology/Lab Coding Alert

Question: We're a reference lab, and we've recently gotten a few Medicare denials with a message that we haven't seen before: Remark Code N347 - Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider by a payment contractor representing the payer. Why are we getting this message, and how can we avoid these denials?


Indiana Subscriber


Answer: Medicare has instituted a new edit to check for duplicate claims for referred clinical diagnostic laboratory and purchased diagnostic services submitted by physicians/suppliers to more than one carrier.

The remittance notice you've described is the notice Medicare sends if the edit detects that another carrier has already paid for the same service.

You should contact the labs that referred the tests to you and ensure that they do not bill for the service. You should bill for a test that your lab performs, and you should use modifier 90 (Reference [outside] laboratory) when you file claims for referred tests. 
 
Medicare's new edit checks for claims from different carriers that have the same information in all of the following fields: beneficiary name, health insurance claim number (HICN), CPT or HCPCS code, date of service, and code modifier. The one exception is modifier 90 - you'll get a denial message even if the referring lab did not use 90 and you did.