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Secondary diagnosis Help!!

  1. Default Secondary diagnosis Help!!
    Clearnace Sale
    Patient primary insur. is BCBS, secondary is Medicare. BCBS paid on services with current DX. Unfortunately, Medicare is not paying on the dx listed for 93306. Patient does have two other diagnoses that we could add to claim and resubmit to Medicare but what are the exact rules for adding dx to claim for a secondary payor??? Any help is appreciated.Gail

  2. Default Any information????
    Does anyone have any suggestions at all??? Thank you!

  3. #3
    Albany, New York
    My feeling has always been that a secondary payor should follow suit with the primary payor.
    However, Medicare and Medicaid seem to want their guidelines followed regardless.
    Was the primary diagnosis used based directly on the report for the procedure? Was the correct CPT code billed?
    Karen Maloney, CPC
    Data Quality Specialist

  4. Default Secondary DX
    Yes, it was coded correctly, I code off of the encounter forms that the doctors check while visiting with patient. Current diagnoses for this patient are 786.09, 782.3, and 401.1. Only 782.3 was on the encounter so that is what I billed, I should have looked at the other dx and added the other two since they are payable with Medicare. I am trying to find out if I can correct my mistake of not listing all of them, and not sure if we are allowed to include the current dx of 782.3 but add the 786.09 and 401.1 and resubmit to Medicare? Thank you, Gail

  5. #5
    Columbia, MO
    I do not feel it is correct to add dx to a claim just for the secondary. You might have to submit a corrected claim first to the primary but I am not certain how that will work for you since they have already paid. When you code for an encounter you should be reading the physicians note to obtain the reason for the encounter and dx testing. too many time the dx listed on the encounter sheet are incomplete and inaccurate.

    Debra A. Mitchell, MSPH, CPC-H

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