E/M Service: Duplicate Denials
Denial Reason, Reason/Remark Code(s)
- OA-18 - Duplicate Service(s): Same service submitted for the same patient
First: Verify the status of your claim before resubmitting. You can determine the status of a claim through the Palmetto GBA eServices tool or by calling the Palmetto GBA Interactive Voice Response (IVR) unit.
Online Claim Status Verification through eServices
- All providers that have an EDI Enrollment Agreement on file may register to use this tool. If you haven’t already registered, please consider doing so.
- Please note: Only one provider administrator per EDI enrollment agreement/per PTAN/NPI combination performs the registration process. The provider administrator can then grant permission to additional users related to that PTAN/NPI.
- Billing services and clearinghouses should contact their provider clients to gain access to the system
- Specific instructions for accessing claim status information through eServices are available in the eServices User Manual (PDF, 8.33 MB)
- In most cases, multiple E/M services that are performed on a single date by the same provider must be combined and submitted as a single service
- We strongly encourage all providers and their staff members to become familiar with the E/M documentation guidelines, which were developed jointly by CMS and the American Medical Association
- Consider using a standardized 'scoring tool' for consistency in applying the E/M documentation guidelines. Palmetto GBA publishes two online E/M scoresheet tools on our website although there are many others from which to choose.
- Conduct internal audits of documentation versus code selections, especially for E/M services