Ask the Coder (542)

I would not send a narrative for this procedure, but the very detailed clinical documentation stating the necessity of the procedure. Unless the patient has implant coverage with their insurance carrier, in most cases the procedure is likely to be denied. Therefore, indicating the need to send as much documentation as possible IF the procedure (more)

There is not a separate code for toothbrush deplaquing. This service would be included in the prophy code, either D1110 (adult) or D1120 (child).

Yes it does because they are putting in a bridge or bridgework.

Did you submit the medical records for the necessity of the procedure? Be honest and open in your documentation - send medical records indicating the necessity of the procedure and a diagnosis to support what was done. You may want to also include a detailed letter that is descriptive of the necessity along with the (more)

D1206 Fluoride Varnish can be appropriate for any person no matter their age. That being said, most insurances will not pay for adults to have D1206. It is best to communicate to the patient they will likely be responsible for the cost of the D1206. There would be two reasons to apply D1206 to a (more)

D9110 is for an emergency palliative treatment. D0140 is to exam a problem focused area. Usually D9110 is for a same day emergency appt and you may only exam, take an X-ray, prescribe Rx or an open and drain to alleviate immediate pain. If this was an appt set up a week or days in (more)

Yes

Since the patient had 4 quads of SRP, the patient is a PM at that point. Just as an FYI, the first PM appointment is usually 90 days post SRP. So, for example, Delta is denying our D4910's within 90 days of SRP. This is a WRITE OFF. Not billable. Since it was NOT past (more)

It is very likely that the insurance is going to deny the second D9222 and D9223. I would submit medical records indicating the need for general anesthesia the second time (twice in a day). This is a rare occurrence, and it's likely that it will be denied as you already had the patient sedated once (more)

This can be reported twice if both upper quadrants are augmented. I would recommend sending documentation to support both the UL and UR quadrants so there is no question as to overbilling the procedure. See Coding Companion 2022, Clinical Coding Scenario #3 on page 215 for verification. This procedure is performed to increase the alveolar (more)