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N214 Remark Code: Missing Initial Surgery History

N214 means the payer needed the history of the initial surgical procedure related to this service, such as when and what the original surgery was, and it was missing, incomplete, or invalid on the claim or in the documentation.

Quick facts

Code
N214 (RARC N214)
Status
Active In use since April 1, 2004; last modified March 14, 2014.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The service was denied or held pending the prior surgery information. The provider supplies it; the patient should not be billed while it is fixable.
Official description
Missing/incomplete/invalid history of the related initial surgical procedure(s).
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N214 means

Some surgical services only make sense in light of an earlier operation. A revision corrects a previous procedure, a reconstruction follows an earlier removal, and a staged procedure completes work that began in a prior session. Payers often base coverage on what the first surgery was, when it happened, and whether it was covered. N214 says that history was missing or unusable. It frequently accompanies CARC 16 or CARC 252.

Common causes

  • The claim did not reference the original surgery, and no operative history was attached.
  • The original surgery happened at another facility and the records were never obtained.
  • The history was provided but lacked a date or did not describe the procedure clearly.
  • The original surgery was cosmetic or non-covered, and the payer wants to verify before covering the follow-up procedure.

How to fix it

  1. Identify the initial procedure and its date from the patient’s history.
  2. Obtain the original operative report from your records or from the facility or surgeon who performed it.
  3. Send the history and report through the payer’s attachment process, or add a brief note in box 19 if the payer allows narrative there.
  4. If the claim itself needs a reference or modifier to link it to the original procedure, submit a corrected claim with resubmission code 7 and the original claim number.
  5. If coverage is denied because of the original procedure, appeal with documentation showing why the current service is medically necessary on its own.

How to prevent it

For revision and staged procedures, collect the prior operative report during pre-authorization rather than after surgery. Surgeons can include a short history of the prior procedure in their operative note, which makes it easy to supply if the payer asks.

Codes that may appear with N214

  • CO-16 (Claim/service lacks information or has submission/billing error(s).): The claim lacks information needed to adjudicate; N214 names the initial surgery history.
  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): Documentation is required, such as the original operative report.
  • CO-107 (The related or qualifying claim/service was not identified on this claim.): The related or qualifying claim or service was not identified on this claim.
  • N233 (Incomplete/invalid operative note/report.): The operative note or report was incomplete or invalid.
  • M29 (Missing operative note/report.): The operative note or report was missing.
  • CO-B15 (This service/procedure requires that a qualifying service/procedure be received and covered.): The service requires that a qualifying service be received and covered first.

N214 FAQ

What kinds of services trigger N214?

Revision surgeries, removal or replacement of implants, reconstruction following an earlier procedure, and staged procedures. Coverage for these often depends on the original surgery.

What information should I provide?

Usually the date and type of the original surgery, who performed it, and the operative report. Some payers also want to know whether the original surgery was covered.

What if the original surgery was done elsewhere?

Request the operative report from the other facility or surgeon, or summarise the history from your own records if the payer accepts that.