Ask the Coder (415)

You are coding this incorrectly: The office visit depending on the documentation noted in the chart should be D0140 or D0160, as this is either a limited oral evaluation focusing on one specific problem or a detailed exam focusing on one problem, however, the patient may have physical limitations or on medications that require a (more)

Delta Dental Utilization Review Guidelines specifically state the following: CDT: This procedure modifies the bony support of the teeth by reshaping the alveolar process to achieve a more physiologic form. This may include the removal of supporting bone (ostectomy) and/or non-supporting bone (osteoplasty). Other procedures may be required concurrent to D4260 and should be reported (more)

Depending on the diagnosis code you used their may be repercussions to the patient (i.e. if you placed a diagnosis of malignancy and it was benign) Once the claim is processed you will need to immediately put in for a claim correction with Medicare, they will usually ask you to use one of the forms (more)

In some cases a prophy may take two appointments if it is considered a "difficult prophy". If your hygienist does not feel the patient meets requirements for a RPS and only meets the criteria of a prophy then a prophy should be billed. However, you should note on the claim form in the remarks area (more)

Can you charge each individual tooth as a single unit or a one fee for the whole bridge?

D9310 is really used for second opinions or specialty consultations. Depending on the documentation and detail of the exam the more appropriate code would be either D0140 or D0150. Remember the documentation must support the level of service.

If the provider is doing more than just a pulp vitality test, which I am sure according to the notes he/she is then you would code both the exam as D0140 and the pulp vitality test D0460 as it would be appropriate to bill both.

No we do not have an area for documentation requirements, however, your question has been submitted to the advisory board for consideration.

The doctor used D9911 and my insurance Cigna doesn't cover, I've to pay $1000. I was even not aware that insurance doesn't cover it. I'm wondering if the doctor can use D9910 instead which is covered by insurance.

If 4 bitewings and 3 PA's are taken on the same visit the appropriate way to code this visit would be the following: D0274 x 1 (bitewings- four radiographic images) D0220 x 1 for the 1st PA (periapical first radiographic image) D0230 x 2 for the additional 2 PA's taken (periapical each add image) Your (more)