ladyathena59808
New
Hello,
I'm looking for some solid documentation on what sort of federal guidance there is on billing a claim to a secondary insurance with dx coding changes.
Obviously, CPTs/HCPCS must be the same between both payors. It makes sense to me that dx codes should also be the same; thus, if the primary payor is billed, pays, and then a dx change occurs, no matter how small, the primary must be corrected; you cannot simply bill the secondary with the new codes. Another example: If the secondary ins does not allow a dx that the primary has already paid on, coding reviews and determines that a dx change is appropriate, the claim with the primary ins should be corrected rather than just correcting the claim to the secondary.
However, I'd like to find documented guidelines on this.
Any help would be appreciated!
I'm looking for some solid documentation on what sort of federal guidance there is on billing a claim to a secondary insurance with dx coding changes.
Obviously, CPTs/HCPCS must be the same between both payors. It makes sense to me that dx codes should also be the same; thus, if the primary payor is billed, pays, and then a dx change occurs, no matter how small, the primary must be corrected; you cannot simply bill the secondary with the new codes. Another example: If the secondary ins does not allow a dx that the primary has already paid on, coding reviews and determines that a dx change is appropriate, the claim with the primary ins should be corrected rather than just correcting the claim to the secondary.
However, I'd like to find documented guidelines on this.
Any help would be appreciated!