Part B Insider (Multispecialty) Coding Alert

Published on Sat Jun 13, 2009 PDF

• Get ready to see a new remark message this fall if your claims don't contain the required ordering physician ID number.

Starting Oct. 5, MACs will begin Phase 1 of the physician ID edit. They will still process a claim when an ordering doc's National Provider Identifier (NPI) number isn't in the PECOS or contractor file, CMS explains in Transmittal No. 510 (CR 6417). But the claim will carry a new remark code: "M68 (missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification)."

What this means: If your doctor has a valid NPI but has not updated his enrollment in the last five years, he may not be in the PECOS system. If he is not, this remark code will be generated not only for your physician, but for all services that your doctor referred to another provider for diagnostic services or consults.

When CMS begins Phase 2 of the project, claims without a valid physician NPI will get rejected, CMS notes in a related MLN Matters article at www.cms.hhs.gov/MLNMattersArticles/downloads/MM6417.pdf. The reissued transmittal is at www.cms.hhs.gov/transmittals/downloads/R510OTN.pdf.