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!

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Asked on November 19, 2010 8:19 am
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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.

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Answered on November 20, 2010 8:19 am
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