Skip to main content

N459 Remark Code: Missing Discharge Summary

N459 means the discharge summary is missing. The payer needs the document that summarizes a patient's stay, including the course of treatment, condition at discharge, and follow-up plan, and it was not received.

Quick facts

Code
N459 (RARC N459)
Status
Active In use since July 1, 2008.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The claim is held or denied until the summary is supplied. The facility or provider submits it; the patient is not billed.
Official description
Missing Discharge Summary.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N459 means

The discharge summary is often the single most useful document for someone reviewing a facility stay. It explains why the patient was admitted, what was done, how they responded, and where they went afterward. Payers request it to confirm medical necessity, length of stay, and the discharge disposition reported on the claim. N459 says the payer did not receive it.

It is usually paired with CARC 252 (documentation required) or CARC 226.

Why these claims stall

  • Summary not finished. The attending provider has not completed or signed it, so health information management cannot release it.
  • Request missed. The payer requested records and the request went to the wrong department.
  • Attachment not linked. The summary was sent, but without the claim number, so the payer could not match it.
  • Only partial records sent, leaving out the summary itself.

What to do

  1. Confirm the request details, including the deadline and where to send records.
  2. Check that the summary is final and signed. If not, escalate to the attending provider through your facility’s incomplete-record process.
  3. Release the summary with the claim number, patient, and dates of stay on the cover sheet.
  4. Track the payer’s receipt and request reprocessing.
  5. Appeal if the payer has already closed the claim as denied and will not reopen it for late records, attaching the summary and a brief explanation.

How to prevent it

Monitor incomplete records aggressively, since an unsigned discharge summary can hold up payment for weeks. For payers that routinely review certain stays, send the summary with the claim.

Codes that may appear with N459

  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): Documentation is required; N459 specifies the discharge summary.
  • CO-226 (Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete.): Information requested from the provider was not provided.
  • CO-163 (Attachment/other documentation referenced on the claim was not received.): An attachment referenced on the claim was not received.
  • N460 (Incomplete/invalid Discharge Summary.): The discharge summary was received but was incomplete or invalid.
  • N451 (Missing Admission Summary Report.): The admission summary report is missing.
  • N50 (Missing/incomplete/invalid discharge information.): Discharge information on the claim itself is missing, incomplete, or invalid.

N459 FAQ

Which claims usually need a discharge summary?

Inpatient hospital, skilled nursing, rehabilitation, and other facility stays under review, plus some workers' compensation and property and casualty claims.

What if the summary hasn't been dictated yet?

Work with the attending provider and health information management to complete it. Payers generally need the finalized, signed summary.

Is N459 the same as a problem with discharge status on the claim?

No. N459 is about the document. Problems with the discharge date or status fields on the claim are flagged with other codes, such as N50.