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Tag Archives: primary

Primary or Secondary Achilles Repair??

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Can someone clarify the difference between a primary and secondary achilles repair (27652 vs 27654)?

Supercoder says that a secondary repair, 27654 is when "The provider performs repair of Achilles tendon for the second time with or without use of graft because the previous one was unsuccessful or the patient reinjured the tendon."
But I read elsewhere that a primary repair is when the injury is acute, and a secondary is when the condition is chronic.

I’m trying to code for a patient who injured her achilles over a year ago but hasn’t had it repaired before. So is it primary because this is her first repair, or secondary because the condition is chronic??

Thank you for your help!!

Medical Billing and Coding Forum

Change to E77.1 (Aspartylglucosaminuria) as an acceptable primary dx?

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Hi everyone!

A patient who has been on our hospice service came in with this code as their primary dx in April. Claims through Kaiser have always been accepted. When trying to get their October claim filed, however, it was suddenly kicked back to us as an unacceptable primary code.

I have not found anything that would support it’s sudden exemption as it is an HCC and rare so it would not make logical sense that it was suddenly removed from the acceptable list.

Any help would be most appreciated!

Lynn McDougal, CRC

Medical Billing and Coding Forum

OB Experts Read!!Ob care and Delivery. Commercial primary and Medicaid secondary

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Hello guys!

Any guidance is highly appreciated. If a patient has commercial insurance as primary and Medicaid secondary. How would you bill their OB care and delivery. Commercial bills global codes but Medicaid does not. Reason I ask is because she has a deductible with her primary but Medicaid will not cover the codes we bill to commercial if we were to forward the claim to Medicaid. Please advise! I am so confused!

Medical Billing and Coding Forum

Billing OB Care and Delivery when Patient has Commercial Primary Medicaid Secondary

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Hello everyone!

I have not done OB/GYN specialty for long and having some confusion with this scenario. I have a patient who has Aetna as their commercial but has Medicaid as secondary. She has a deductible to be met on her Aetna policy and I know Medicaid will not pick up the codes that will be billed to Aetna for the global delivery. What is the proper way to bill this? Please advise!

Medical Billing and Coding Forum

Primary not the admitting

Posted on by
I’m confused as to why my scrubber continues to error our my 99222 claim. My physician is the patient’s PCP and did not admit the patient; however, he does see them each day they are in the hospital and does assist to manage care for the patient. When he is notified of the patient admission, he typically will go the next day. The admission date on the claim will be the date the patient was admitted, but my date of service for that claim is the date he saw the patient (typically the next day). My scrubber is erroring the claim stating that the date of admission must be the same date as the date of service. Am I missing a modifier? Any assistance would be appreciated, as I’m new to all of this.

Medical Billing and Coding Forum

Medicaid as primary or secondary- Can we charge the patient if they dont pay?

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if a patient has Medicaid as secondary can we trasnfer the balance to the patient if Medicaid does not pay? Because I know if the pateint has MEdicaid we can’t trasnfer the balance to the patient; however, if Medicaid does not pay is it still okay to charge the patient the balance? not sure if that applies when its primary and secondary or only primary.

Medical Billing and Coding Forum

submitting claims to primary commercial ins and secondary ins medicaid

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I have a co-worker who insists that when 99395 is submitted to the primary commercial ins and denied, that the 99395 code can be changed to a 99214 to submit to the secondary ins medicaid plan first to receive payment. I thought this was illegal but I would like to find some information to print off regarding guidelines on this.
Any help would be appreciated.

Judy in Mobile

Medical Billing and Coding Forum

Primary CPT for IVUS CPT 92978

Posted on by
Hello,

I was wondering if folks could chime in on their understanding of what Primary CPT’s are compliant with CPT add on 92978 (IVUS).

Per CPT: "Code first primary procedure (92920, 92924, 92928, 92933, 92937, 92941, 92943, 92975, 93454-93461, 93563-93564)"

Given the fact CPT is Physician based and when DES is placed the C9600-9608 range comes into play for hospitals.

My understanding is C9600, 9602, 9604, 9606 and 9607 are equivalents to the Stenting CPT 92928, 92933, 92937, 92941 and 92943 listed as primary CPT for IVUS 92978.

I know CMS updated the edit that was in place back in 2014 to allow C code range with IVUS CPT 92978 as well.

Dr. Z Q/A supports use of C9600, 9602, 9604, 9606 and 9607 as primary CPT for IVUS CPT 92978. I am recieving conflicting feedback from other coders based on the fact CPT does not list the C Codes as primary.

What is everyone’s understanding of compliant billing in setting when PCI performed with DES and IVUS also perfomed. Cardiac catheterization was not performed in the same encounter. Can we compliantly code IVUS 92978 with C9600, 9602, 9604, 9606 or 9607 as the primary?

Does anyone else have additonal resources supporting?

Thank you in advance for your feedback.

Medical Billing and Coding Forum

Medicare primary and we are out-of-network with secondary

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If the secondary payer does not pay because we are out-of-network with them (either they deny the claim or apply it to a large out-of-network deductible), are we allowed to write off the co-insurance since the patient would not have had to pay it if we had been in-network with the secondary?

Medical Billing and Coding Forum