Skip to main content

N678 Remark Code: Post-Op Images or Visual Fields Missing

N678 means post-operative images or visual field test results the payer requires were not received. Without them, the payer can't confirm the outcome or necessity of the procedure, so the claim is denied or held.

Quick facts

Code
N678 (RARC N678)
Status
Active In use since November 1, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The line is held or denied because the provider didn't supply required documentation. It is not a patient balance.
Official description
Missing post-operative images/visual field results.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N678 means

Some payer policies ask for evidence after the procedure, not just before it. Post-operative photographs, radiographs, or visual field testing can show the procedure was completed and what it achieved. When the payer’s policy requires that evidence and none came with the claim or in response to a request, the remittance carries N678.

Visual field results are most often tied to eyelid and brow procedures, where payers want proof the procedure addressed a functional problem rather than a cosmetic one. Pre-operative fields and photos are the usual requirement; a post-operative request is more specific and depends on the payer’s policy.

Common causes

  • The payer’s policy calls for post-operative documentation and the practice sent only pre-operative records.
  • A records request arrived after surgery and went to the wrong department.
  • Images exist in the imaging system but weren’t exported to the billing workflow.
  • Images were sent separately and never linked to the claim.

How to fix it

  1. Read the request or policy to see exactly what’s required: images, test results, or both, and the timing.
  2. Gather the documents from the surgical or imaging record, labeled with patient name and date.
  3. Submit them through the payer’s attachment process, referencing the claim number.
  4. Send a corrected claim with resubmission code 7 in box 22 only if the payer requires a new claim with the attachment.
  5. Appeal if the documentation was sent on time, with proof of submission.

How to prevent it

Build payer documentation requirements into surgical scheduling for procedures with outcome-based policies. Make post-operative image capture part of the follow-up visit, and attach the results to claims for those services.

Codes that may appear with N678

  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): An attachment or other documentation is required to adjudicate the claim.
  • CO-16 (Claim/service lacks information or has submission/billing error(s).): The claim lacks information needed for adjudication.
  • N679 (Incomplete/Invalid post-operative images/visual field results.): Post-operative images or visual field results were received but incomplete or invalid.
  • N178 (Missing pre-operative images/visual field results.): Pre-operative images or visual field results are missing, the more common request.
  • N677 (Alert: Films/Images will not be returned.): An alert that images you submit won't be returned.

N678 FAQ

Which procedures need post-operative images?

It depends on the payer's policy. Requirements are typically attached to procedures where outcome or functional improvement must be shown, and some dental plans ask for post-treatment images too. Check the payer's policy for the specific service.

Can I send pre-operative images instead?

No. If the payer asks for post-operative documentation, it wants proof of what was done or the result. Pre-operative images answer a different question.

What if post-operative images were never taken?

Ask the payer whether other documentation, such as an operative report and follow-up notes, is acceptable. If its policy strictly requires images, the service may not be payable.