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Thread: carve outs and secondary payers

  1. #1

    Default carve outs and secondary payers

    AAPC: Back to School
    I'm wondering if anyone can answer this question. I understand the rules for carving out a sick E/M, pap collection, and pelvic/breast exam from a preventive, but we are debating in our office if you would still do that if they have a secondary that would pick up the cost of the preventive? Do we want to carve out and reduce the price if the secondary will pay or is it a legal requirement that if we carve out for one we care out for all regardless of the secondary payer? Any info would be much appreciated!

  2. #2


    We should not be so much lured by the fact that even the Secondary can pick up the cost of Revenue. We should strictly adhere to Coding Guidelines, bill it to primary without manipulating anything on the amount to be billed. Expect it to be denied (if we know that it is going to be denied by the Primary) and be forwarded to Secondary as appropriately in a routine manner without manipulation...etc.
    Crux of the matter: To get max reimbursement, we should not think of any such manipulations as it came to you.

    Sanjit Kumar Mishra, CPC

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