American Dental Coders Association | Dental Billing & Coding Certification Online

Certifying Dental Billing and Coding Professionals Nationwide

A patient’s dental insurance was billed for 3rd molars and sedation. Insurance charged and paid as follows: D7230 x4 $350; D9241 $300; D9742 $75 for a total of $1775. Dental insurance subtracted the $50 deductible and then paid @ 50% or $862.5 leaving the patient with a balance of $912.50. MY QUESTION THEN is WHAT codes do we use to charge his medical insurance?Also, should we have charged medical insurance first?THANK YOU!

by

  • Ask the Coder
  • A patient's dental insurance was billed for 3rd molars and sedation. Insurance charged and paid as follows: D7230 x4 $350; D9241 $300; D9742 $75 for a total of $1775. Dental insurance subtracted the $50 deductible and then paid @ 50% or $862.5 leaving the patient with a balance of $912.50. MY QUESTION THEN is WHAT codes do we use to charge his medical insurance?Also, should we have charged medical insurance first?THANK YOU!

A patient’s dental insurance was billed for 3rd molars and sedation. Insurance charged and paid as follows: D7230 x4 $350; D9241 $300; D9742 $75 for a total of $1775. Dental insurance subtracted the $50 deductible and then paid @ 50% or $862.5 leaving the patient with a balance of $912.50. MY QUESTION THEN is WHAT codes do we use to charge his medical insurance?Also, should we have charged medical insurance first?THANK YOU!

« Back to Previous Page
Answer Question
▲
0
▼
♥ 0
Marked as spam
Posted by
Asked on November 19, 2010 8:19 am
Add comment
Cancel

Answers (1)

▲
3
▼
✔
Private answer

The appropriate code for the extractions would be 41899 with the use of modifiers, so your claim would look something like this;

41899 UL
41899 UR 59
41899 LL 59
41899 LR 59

The modifiers UR, UL, LL, LR indicate the quadrant, while the modifier 59 alerts the carrier that these are seperately identifiable procedures and therefore should be paid individually. You should go a step further and state in box 19 for your CMS form "teeth involved 1,16,17 & 32. This helps clarify to the carrier the specific teeth involved.

As for the anesthesia the appropriate code would be 00170, you should note this code is reported by time. You are allowed 1 unit for every 15 minutes and you must have at least 5 minutes or more to report an additional unit. So, for example if you have 36 minutes of sedation you are allowed 3 units.

Marked as spam
Posted by
Answered on November 20, 2010 8:19 am
    Add comment
    Cancel
    « Back to Previous Page

    Post your Answer

    Attach YouTube/Vimeo clip putting the URL in brackets: [https://youtu.be/Zkdf3kaso]

    Corporate Profile

    American Dental Coders Association
    9015 W Union Hills Dr Ste 107 #314
    Peoria, AZ 85382
    1-833-469-2322

    American Dental Coders Association BBB Business Review