For extraspinal manipulation, do we have to use a subluxation diagnosis code?
Any diagnosis from Table 6 will be fine (as long as it is logical), including 739.* (subluxation). 739.* is acceptable, but not required. Q: In the demonstration project, if a patient has Medicare benefits and also has 1) Employer health insurance, 2) workers’ compensation, or 3) auto/liability coverage, do will still have to send a claim to Medicare? A: In any ‘Medicare as a Secondary Payer’ (MSP) situation, the physician or supplier must first bill the primary insurer before they can bill Medicare for secondary payment. For example, if a Medicare beneficiary is working and has health insurance through his/her employer, the physician or supplier must send the bill to the employer health plan first. The primary insurer will process and pay the claim as appropriate. The remittance advice must then be sent to Medicare, along with the bill, for secondary payment. The same process must be followed for workers’ compensation or auto/liability claims when Medicare is involved as the secondary
Related Questions
- What information is needed when the hospital is being asked to provide the admitting diagnosis code and additional diagnosis codes at the time of admission?
- If the hospital reviewer doesnt know the diagnosis code, could the HSI nurse provide it?
- What if the admitting diagnosis code (Admit DX) is invalid or not subject to review?
