Answers
Question
I have a patient that has had SRP. He has been on perio maintenance (4910) for a year. If they have improved can they go back to an adult prophy (1110) or do they have to stay at a 4910? I was told once we use 4910 they have to stay with that code.
Lori May 7, 2025 2:13 pm
The American Dental Association has said it's a matter of clinical judgement of the dentist. It is appropriately reported as D4910, but if the treating dentist determines the patient can be treated with routine prophylaxis, then D1110 may be appropriate.
asked 6 months ago by
There are no restriction to bill these two codes together for the same DOS. However, you want to make sure you are include supporting documentation as to why you performed both procedures on the same day and the time involved. Make sure to include ch...
Meg April 9, 2025 6:39 am
Can you bill a pro on one day of service for the initial visit and then ask the patient back for an SRP and bill out SRP on another day of service? Also, is there any restriction on time on when to bring the patient back for SRP after the apro? An established patient came (more)
asked 2 years ago by
i was told you should always take only the primary adjustment but was always taught to take the higher amount. which is it?
medaudsolutions April 8, 2025 3:17 pm
What is the secondary changed their fees/policy? If 100 allowed, primary paid 80, then I would transfer the $20 to the secondary, let the secondary adjudicate then make my adjustments. I am not saying balance bill. The primary allowed 100, I would transfer up to that just like EOB says to secondary. You could be (more)
asked 6 months ago by
Should a Dentist charge a separate lab fee for this type of crown
medaudsolutions April 8, 2025 3:21 pm
Agree with prior post, dentist do not usually charge a lab fee. BE careful charging more than the allowed amount on contracted plans and covered services; that is a compliance no no.
asked 7 months ago by
I am unsure when the CDC-M05 was updated, but the newest edition removed 99201.
Angela April 8, 2025 7:19 pm
It was removed jan 2023 if I am not mistaken.
asked 1 year ago by
If a patient has a primary plan either through an employer or the open market, will as supplementary plan like AFLAC or Colonial Life with no COB be listed as secondary? I just would like some clarification. COB has rules but when there is no COB som...
Austinida April 8, 2025 2:41 pm
Hello! This depends on whether or not the primary plan will even coordinate benefits with a secondary plan. Typically, Aflac and Colonial Life are fee schedule plans where the patient pays the difference between their fee schedule contract fee and UCR. Some Colonial Life or Aflac plans directly reimburse the patient and not the office, (more)
asked 1 year ago by
When billing D0251, should we bill 1 or 2 units of this because it's both the right and left side? And does it matter if it's for primary or permanent teeth?
Austinida April 8, 2025 2:37 pm
Extraoral images are captured when the image receptor is placed outside the patient’s mouth, such as a CBCT or panoramic X-ray. For D0251, you will bill one unit since it is categorized as an image of the entire posterior dental region. This code can be billed for both primary and permanent teeth.
asked 1 year ago by
HI I submitted a prior auth for D2392 and D2929 for several teeth and req to please allow for alt benefit for D2930 and downgrade to amal fee. I received the preauth back with only coverage on D2331 on #R . Can I legally submit a D2930 with our fee f...
Austinida April 8, 2025 2:24 pm
Legally, you must bill out for the procedures that were performed by the provider and the charges billed must match the clinical notes.
asked 1 year ago by
If I send a claim to a primary insurance and they pay a portion and have a contractual adjustment that covers the remaining portion of the balance leaving no patient balance, is it appropriate to send the claim to the patients secondary insurance hop...
Austinida April 8, 2025 2:15 pm
Hello! The patient's secondary insurance always needs to be billed to ensure accurate procedure history, regardless of the amount of the primary insurance's payment. Hope this helps!!
asked 10 months ago by
What is the code for the visit between extraction and dental implant
JLOUD April 8, 2025 1:34 pm
D0171
asked 9 months ago by
