Wiki changing diagnosis code on claim when secondary denies the diagnosis code

[taj0257@msn.com]

Primary insurance (medicare) was billed Aloxi injection J2469 with the patients cancer diagnosis on the claim. BCBS is denying claim because they require a diagnosis of V58.11 for that injection. Can I change a diagnosis when billing to secondary insurance? I was told NO that I cannot because that is fraud but I cannot find a resource to back this up. Help!

 

[chaxton]

to my knowledge if this is a payer specific coding issue than it is okay to change the dx. An example of this is a few years back for BS of California to pay for a screening mammo we had to code a V70.0 in the primary dx position and than the V76.12. So in my opinion this is okay to do.

 

[BlakeCarswell82]

The documentation needs to back you up.

 

[alyssak88]

Correct Claim

The only way this wouldnt be considered fraudulent is if you submit a corrected claim to the primary insurance with the new dx let them bill with the new diagnosis and then let it go to secondary, and make sure the documentation backs up the diagnosis as well. Before doing that I would make sure the new diagnosis will be covered by the primary and double check the NCD/LCD.