Ask the Coder (163)

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.

You may use either D0120 or D0180, you will need to check with your carrier for specific guidelines.

Since they are a requirement by some insurance companies on the CMS-1500 form I would say that it is also a good idea to enter them on the UB-04 form, but I cannot find documentation that states that it's a requirement. You might want to check with the insurance carrier to be sure.

The D0140 should only have been sent by the GP, If it was certain the patient needed to RCT. The endo coding for it is not neccassary unless they had to diagnosis if the patient really needed a RCT. But the GP sending the D0140 again at the crown appointment is absolutely unnecessary. Most insurances (more)

The most appropriate CPT code is the unlisted code 21089, this code requires a narriative to accompany the claim.

Unfortunately, I can't exactly explain why a payor would request a tooth surface, but it may be a requirement of the plan for the code. This is probably given to be sure that duplicates are not billed. Also, they are typically subject to a 5–10-year limitation. There can be quite a few limitations to these (more)

Hi, Which are you submitting? The missing tooth or the crowns?

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)

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