Ask the Coder (544)

Answers

Question

answer

Our client owns a pediatric dental clinic. The code that my client uses on a maximum basis is 9248 in conjunction with 9230. The total UCR for these is 295 and 55 respectively. They are mostly used together. So this puts my client in a situation that if they are covered, then he gets paid less, because usually the parent would pay out of pocket for these, and the whole procedure would make sense. Now with such a low fee, it does not make sense considering the stress involved. Is there any alternative way/ code(s) to charge for non-intravenous sedation using inhalation of Nitrous Oxide. Is there any scope of charging, using ASA (CPT) codes if the patient also has medical insurance coverage apart from dental coverage?

Admin March 12, 2015 4:02 am

You may code 00170 for the sedation and still use D9230 for the nitrous oxide to the medical carrier for reimbursement.

asked 11 years ago by

ADCA Admin

answer

My concern is regarding the sedation codes used for dental anesthesia as - D9220. D9221, D9230, D9241, D9242 and D9248. If the provider is credentialed as a specialist, will there be a difference in the amount paid and allowed by the insurance companies?

Admin March 12, 2015 3:52 am

Usually there is a slight difference is the amount paid; this is carrier driven so it is best to check the Utilization Review Guidelines for each carrier to determine reimbursement levels.

asked 11 years ago by

ADCA Admin

answer

what code do u use for implant

Admin March 6, 2015 1:48 pm

Without specific information the most common code usage for an endosteal implant would be dental code is D6010 or CPT Medical code 21248

asked 11 years ago by

ADCA Admin

answers

We use code D5865 for a complete mandibular overdenture, but it only pays about $1000. Our cost is about $4000. Is there a different code we are supposed to use or is there an additional code that I should use?

Julia March 23, 2023 1:17 pm

The ADA gives instructions on coding for overdenture. It's not only the overdenture but also each precision attachment that you would code for. Hope that helps! https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/publications/cdt/cdt_overdenturecodingguidance_naturaltoothborneandimplantborneprostheses_2020nov.pdf

asked 11 years ago by

ADCA Admin

answer

Please advise coding on the following: Pt. presents with pain, swelling around #3--took 2 PAs and measured pocket depths in area--sulcus of #3 gushed pus and blood when probed--doctor treated as perio abscess by doing gross debridement to let it drain through the sulcus, irrigated with Chlorhexidine and prescribed antibiotics.

Admin March 5, 2015 10:28 am

The most appropriate codes for your scenario are as follows: D0220, D0230, D4921

asked 11 years ago by

ADCA Admin

answer

How would you code for the following: an 8-year-old presents with lacerated lip--IM injection of Ketamine for sedation--debridement of the wound with 2 sutures placed

Admin March 4, 2015 10:24 am

Without specifics(how big is the laceration, was a limited exam performed) the following codes are the most appropriate for the scenario listed above. Dental: D9241, D7530, & D7910

asked 11 years ago by

ADCA Admin

answer

How do I code for a super-erupted tooth #15?

Admin March 4, 2015 10:22 am

ICD-9-CM code 520.8

asked 11 years ago by

ADCA Admin

answer

How do you code for the cast metal parts of a Maryland bridge that are bonded to the lingual of the adjacent teeth?

Admin March 5, 2015 10:20 am

Without specific information as to whether this was a repair or initial placement the most appropriate codes would be D2980 or D2999