3 surface filling billing

3 surface filling billing

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If you do a DO filling and a B filling on the same tooth and the DO does not touch the B can you bill for 2 seperate fillings the same day?

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Asked on November 16, 2022 8:24 am
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It is inappropriate and fraudulent to code two separate fillings on the same tooth when a more appropriate code exists. This kind of billing is called unbundling and is considered fraudulent and abusive. Rule of thumb: always code to the highest level of specificity, meaning if a more appropriate code exists use the more appropriate code at all times.

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Answered on November 16, 2022 8:36 am
Unfortunately, this answer is incorrect. If you look in the CDT 2023 Coding Companion on page 110 Q& A #3, it states: How do I report two-surface restorations on the same tooth ? Carriers advise me to report a MO amalgam and a DO amalgam as a MOD restoration. Is this correct? Answer: The carriers' advice is incorrect. Dentists must document the procedures performed and in this scenario, there are two separate two-surface restorations, an MO and a DO. Guidance applicable to reporting procedures on a single tooth is found in the CDT manual's "Explanation of Restorations." Following the carrier's advice will lead to a discrepancy between your accurate patient records and the carrier's claim records. Such a difference may become a problem during any audit or other review of services rendered.
(Shannon Taylor at November 16, 2022 2:36 pm)
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Yes, for example if it is a composite filling on tooth #19 DO and B - you would code as such:
D2392-19-DO
D2391-19-B
Most insurances will down grade it to a one three surface filling. If you are in-network you will have to adjust the difference off. You cannot help how insurance companies process claims. No matter what always code exactly what you do.

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Answered on November 16, 2022 8:30 am
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Yes the insurance may pay it as billed or will down code it.

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Answered on November 16, 2022 10:47 am
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As long as the decay does not extend or connect to the buccal surface, you are coding correctly. Sending an x-ray can support that you did code the procedure correctly and you are not bundling. Insurance companies typically approve a 3 surface benefit in these cases.

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Answered on November 16, 2022 1:06 pm
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