How to charge for downcoded D4260

How to charge for downcoded D4260

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D4260 may be downcoded to D4261 due to periodontal charting . Isf full quad of surgery is done, is the patient responsible for the difference up to the full quad fee of the limited quad fee?

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Asked on March 9, 2022 9:00 pm
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You're stating that the insurance downcoded the procedure based upon the evidence of the perio chart? It would depend on if you are in network or out of network with the insurance company as to how they process the difference when they downcode the procedure. If you are in network, it's likely that they process it as a write off. If you are out of network it will depend on the payor, but they may make the difference the patient responsibility. Chances are, the difference will be written off in most cases.

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Answered on May 15, 2022 7:44 pm
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