Hello. Does anyone know if we should collect secondary insurance copay? 1 office I know they do not, another they do.
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Tag Archives: secondary
Primary vs. Secondary Hypertension
I have a cardiology office visit case wherein the Problem List in the medical documentation states, among many other conditions, "Hypertension, hard to control secondary to left ventricular noncomliance and aortic inelasticity." However, later on, in the assessment, it is stated, "Blood pressure well controlled."
My inclination was to code secondary hypertension, e.g., I15.8 Other secondary hypertension (although I’m not sure how I would report left ventricular noncompliance or aortic inelasticity). However, another coder stated that, since the assessment indicates "blood pressure well controlled," I should simply report I10.
Is this good advice? If so, why? Is it because it’s well controlled (doubt that’s a good reason), or is it simply because in the assessment, the doctor chose not to characterize the hypertension as secondary?
Thanks,
Jim Shaw, CPC-A
HELP…. i have billing primary and secondary question(s)
Hello All,
I could really use some help. I’m confused when billing primary and secondary. Question. What do you do when a secondary pays as primary but when you call the secondary they say they paid as secondary but now your computer show an insurance refund. Who gets the refund? how would you enter the secondary’s payment? What (if there is a) balance would be the patient balance? Example: total billed amount $ 5,949.00 primary eob states allowed $ 4,242.34 Coinsur $ 848.47 adjustment $ 1706.66 Paid $ 3393.87 …. Secondary’s eob states allowed $ 5354.10 deduct $ 421.98 adjustment $ 594.90 Paid $ 3945.70 ….
Do I refund the primary’s full pymt and base the claim payment on just the secondary’s payment?
THANKS 
MIPS payment posting by secondary payers
When our Medicare claims cross over to Medicaid, Medicaid is not reading the MIPS adjustment code correctly. They are applying the adjustment against the CO-45, creating a patient balance of what Medicare’s MIPS amount was.
Medicare when primary is processing MIPS correctly and the payments are posting correctly.
Is anyone else seeing this with their Medicare crossover to Medicaid claims?
Thannks for any input!
Allowable amounts for primary and secondary
Hi, I am hoping somebody can help with this scenario and also provide somewhere were I can find the proper documentation to support the decision:
Patient has commercial insurance A as primary, commercial insurance B as secondary. Provider is in network with both A and B.
Insurance A shows an allowable amount of $ 65, pays $ 55, patient responsibility is $ 10.
Insurance B shows an allowable amount of $ 100, pays $ 0 (applies to deductible), patient responsibility is $ 100.
Is provider supposed to bill the patient for the $ 10 per Insurance A patient responsibility,
or $ 100-$ 55 paid by insurance A=$ 45 per Insurance B.
Any help would be appreciated – as well as where I can find the documentation regarding this.
Thank you,
Susan Wood, CPC-A, CPB
s/p revision of vaginal septum resection secondary to postoperative hemorrhage
I am trying to code for s/p revision of vaginal septum resection secondary to postoperative hemorrhage but I am at a loss. Has anyone else coded for this before? Thanks in advance 😮
Operation – Exam under anesthesia, Repair Vaginal Tear, revison of vaginal septum resection ,control of post op hemorrhage
The patient was taken to the OR where general endotracheal anesthesia was induced. The patient was placed in the dorsal lithotomy position with her legs supported using candy cane stirrups. The patient was then prepped and draped in the normal sterile fashion. A time-out was performed to confirm correct patient, correct procedure. A deaver retractor was used to visualized the vagina. A large clot was evacuated. The vagina was then copiously irrigated with sterile water. The vagina was then inspected and a largely intact incision was noted longitudinally, both inferior and superior. Two cervices were noted and appeared normal. An small area of separation was noted, with a small amount of active bleeding. The posterior portion of the incision was oversewn from the apex to the introitus using 3-0 vicryl in a running/locked fashion. One small area about 1 cm above the introitus in this incision line continued a bleed. A figure of 8 was placed using the same suture. Excellent hemostasis was noted. The vagina was then packed the Kerlix with premarin cream. A foley catheter was placed without difficulty. All sponge, lap, and needle counts were correct x 2 at the end of the procedure. The patient tolerated the procedure well and was transferred to the recovery room in stable condition.
Billing with primary and secondary insurances
Looking to verify the proper patient responsibility to bill them in the following scenario as well as the proper rationale.
Primary insurance is a high deductible plan through BCBS and allows $ 3000.00 to the patient’s deductible for a patient’s surgery on the $ 5000.00 billed charges. We do not participate with the primary insurance. It’s a PPO plan. They were covered by the out of network benefits on the plan. BCBS says the patient’s responsibility is the $ 5000.00.
Secondary insurance is Medicare and we do participate. Medicare allows $ 1000.00, pays out $ 800 with $ 200 coinsurance. Patient responsibility on remit says $ 200.00.
Do you bill the patient only the 20% coinsurance for $ 200?
Or do you bill the patient for $ 4200.00 ($ 5000.00 minus $ 800.00 paid by Medicare)
Secondary Office visit Billed with Annual Physical
I have a Physician who regularly bills an Annual Physical (99395-99397) with an Office visit E/M(99212-99215). I have tried telling him the differences as to when and how this should be done and for the most part, he has cut down on billing an office visit(99212-99215) with an Annual Physical(99395-99397).
One scenario that keeps coming up however is when a Patient comes in for an Annual Physical, had bloodwork beforehand, is found to have "Vitamin D Deficiency" and then the doctor bills for the Office visit on top of the physical for treating the Vitamin D Deficiency (same goes for B12).
I don’t necessarily think that this qualifies as a significant, separate service but I’m not sure that I have a good argument against it. This doctor’s argument is pretty much, ‘well it’s a new diagnosis and I wrote a prescription for it.’ While I think about the patient receiving a copay or a deductible bill for this and trying to explain to them why they got a bill for Vitamin D deficiency. I think most people would be upset that they got billed separately for this but I can’t tell if I’m looking at this scenario objectively or not.
Is my doctor right in billing separately for this service along with an Annual Physical or am I right in thinking that there just isn’t enough work involved in diagnosis a Vitamin deficiency to bill separately for it?
Dilated cardiomyopathy secondary to Rheumatoid Arthritis
Hello,
Looking for some feedback as what to code for provider stating:
Dilated cardiomyopathy secondary to Rheumatoid Arthritis:
Should it be I42.0 (dialated cardiomyopathy) + M06.9 (Rheumatoid arthritis, unsp)
or
M05.30 (Rheumatoid Arthritis with heart disease, unsp
Any help appreciated!!
Donna
Primary or Secondary Achilles Repair??
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!!