primary

  1. J

    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...
  2. E

    Denial from Primary

    If a patient has two insurances and the primary denies (denial is appealed and upheld), do you have to bill the secondary insurance? A co-worker was told to adjust and to not bill the secondary at all.
  3. D

    Billing primary codes/add-on codes on separate claims for same date of service

    Hello- If one provider performed the primary procedure, and a different provider on the same date of service performed the add-on procedure, is it possible to bill these codes on two claims under each individual provider's credentials within the same facility? For example: Dr.A performs...
  4. C

    Default coding for Osteoarthritis

    Can anyone tell me if there is any literature that tells what the default codes are for osteoarthritis (unspecified, primary, secondary)? I have heard default is primary, I have heard you have to go to unspecified. Can anyone provide me with any proof/literature to support their position? i.e...
  5. C

    Default coding for Osteoarthritis

    Can anyone tell me if there is any literature that tells what the default codes are for osteoarthritis (unspecified, primary, secondary)? I have heard default is primary, I have heard you have to go to unspecified. Can anyone provide me with any proof/literature to support their position? i.e...
  6. C

    Wiki Default coding for Osteoarthritis

    Can anyone tell me if there is any literature that tells what the default codes are for osteoarthritis (unspecified, primary, secondary)? I have heard default is primary, I have heard you have to go to unspecified. Can anyone provide me with any proof/literature to support their position? i.e...
  7. D

    J06.9

    Can J06.9 be used as a primary code?
  8. S

    Bill established then bill new patient code?

    Is there any documentation that addresses whether you can bill an established code prior to billing a new patient code? This seems counter intuitive however, we have a situation where we have an Immediate Care clinic that is modeled after an Urgent Care (without the Urgent Care designation.)...
  9. A

    Need dx help from experienced mental health coders--please help!!

    I am assigned the coding for the neuropsychologist at our health care organization, and I have very little experience in this area. I'm having an obstacle when it comes to diagnosis coding for CPT 90791. Many of the patients in question are diagnosed with delirium, F05. This dx code requires...
  10. L

    Billing Proctored Cases

    Dr. A. is proctoring Dr. K. in abdominal aortic endografts. Based on the dictation, it looks like Dr. K. was the primary operator, but Dr. A was also listed. Would a modifier -62 be the most appropriate in this case, or does the fact that it's a proctored case change things? Thank you! Edit...
  11. M

    Wiki Chapter 19 as Primary Dx

    Hello, I am new to coding and learning ICD-10 rules. The software program I am using at work is not letting me use anything from Chapter 19 as a primary dx with an outpatient CPT code. The examples in the ICD book make it look as if chapter 19 codes can be used as primary... is it just my...
  12. N

    Need Help Concussion Coding

    Need some guidance on concussion coding, patient comes in with concussion without loss of consciousness still having problems with headaches and fatigue referred by family physician, our provider coded S06.0X0S, I don't agree I think it needs to be coded F07.81 then S06.0X0A initial encounter...
  13. P

    djd knee dx

    question: report states "DJD left knee"... I have been coding as M17.12, but my supervisor says that is should be M17.9 for unspecified. I disagree, on the thought that it says left knee, and if it does not state either primary or secondary, it defaults to primary.....any help would he...
  14. M

    Coding of unknown primary neoplasm site

    Hi! Need a quick answer before my class tomorrow. In the below case, would you still code an unknown primary site? Metastasis to Zuckerkandl's organ. The answer in the text book provided for the unknown primary site, despite having no mention of the primary site. Can you help me come up...
  15. C

    NC Tracks(NC Medicaid) and assistant to surgery Modifier denial

    Good Morning, Just wondering if anyone else is having trouble getting paid for assistant to surgery for PA's. We are filing with CPT code 37225- 80. Medicare is paying as primary and then medicaid denies stating CPT/modifier combo is invalid. When the AR girls call NC Tracks all they will tell...
  16. H

    Will Medicaid pay if Medicare denies in NC?

    I am having trouble finding the answer to this question. We have a patient who only has Medicare part A primary and Medicaid secondary. If part A doesn't apply to us, can we file Medicaid and expect payment? If so, would you file the claim as primary or secondary with the information of...
  17. M

    coding I50 series HELP

    We are recieving rejections for these codes due to it needing a primary dx. In the ICD-10 book it states: "code first:- and gives examples" Is this really no longer a stand along code? or is this stating that if the patient has one of these conditions listed, it must be coded first and then the...
  18. S

    Wiki pulmonary hypertension codes

    I find myself confused when coding echos with the pulmonary hypertension codes. When do I code secondary vs primary pulmonary hypertension?
  19. M

    coding I50 series

    We are recieving rejections for these codes due to it needing a primary dx. In the ICD-10 book it states: "code first:- and gives examples" Is this really no longer a stand along code? or is this stating that if the patient has one of these conditions listed, it must be coded first and then the...
  20. S

    HUMANA denial for J02.9 not allowed as primary

    We just received a denial from Humana insurance stating that J02.9 is an invalid primary dx code. I do not see any specific guidelines for that code saying it cant be primary. Can someone please let me know if they are having trouble with this also. Thank you
  21. M

    Primary Care Exception

    Your help is needed in regards to the Primary Care Exception of Teaching Physician guideline for Medicare. It is my understanding that under the Primary Care Exception we are only allowed to bill for services of 99201-99203 and 99211-99213. Any other service than those do not fall under the...
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