Ask the Coder (565)

Yes, that is correct. You cannot bill D4346 because that does not meet the clinical criteria and D4910 cannot be coded. That can only be billed after SRP is completed. If the patient is refusing any treatment it should be documented in their chart. Also, I would recommend having them sign a denial of dental (more)

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I’ve worked for an FQHC for 13 years, and yes, you can bill contractual to secondary Medicaid when the primary is a commercial plan. The rules could vary by state, I would recommend locating a contact within your state Medicaid office and ask.

Hi! No, you should not bill D0220 for an occlusal image. The intended use of a true PA is to capture the entire tooth crown to apex, and the surrounding bone. Occlusal radiographs are a different type of image that shows a broader area, not a focused periapical view. CDT coding is based on the (more)

Hi! For WT ext's, the diagnosis code depends on the clinical reason for removal of the tooth. There is not one single ICD-10 code that applies to all wisdom teeth. K01.1- impacted teeth; K00.6- disturbances in tooth eruption (unerupted/ partially erupted w/o full impaction); K08.3- retained dental root (for residual tooth roots). For medical cross-billing, (more)

Hi! Generally, a provider can offer a cash discount (self-pay discount) to patients who do not have insurance or patients who are not using insurance for their visit. A self- pay patient discount is generally allowed, as long as it is applied consistently and not tied to avoiding insurance billing (i.e., not violating payer contracts (more)

D8220 for a lingual arch appliance (fixed appliance therapy). D1510 is for a fixed unilateral space maintainer, and D1516 is a fixed bilateral space maintainer.

Medical ins requires CPT codes rather than CDT codes. When a hospital bills CPT 41899 (unlisted dentoalveolar procedure) for dental restorations performed under general anesthesia, the dentist would bill dental insurance using the appropriate CDT restoration codes (such as D2330-D2394 for composite restorations) and D9223/D9222 for general anesthesia. If billing medical insurance for anesthesia, the (more)

D7880 is the correct code for an EMA device

Hi! You would post the primary payment, transfer the full balance remaining for the code to the secondary, then do the final write off after secondary insurance processes the payment... example: D0120 is $100. Delta pays their contracted fee of $40, you post the Delta payment, transfer the $60 remaining balance to Health Partners, send (more)