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If a patient was present in our office for a problem focused exam D0140 and it is diagnosed that they have infection and need to return for an extraction or have a RCT performed in another office. They had not done either treatment and returned one month later with infection again with pain in the same tooth. What code should be used for the second visit? No treatment was able to be performed on either visit due to extensive infection and the need for antibiotic treatment prior to extraction or RCT.

Admin November 4, 2014 12:27 pm

Depending on the carrier you may use either D0140 again or D0170. You will need to check with the particular carrier as each have their own utilization review guidelines.

asked 11 years ago by

ADCA Admin

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What would be the correct code for a first time patient under the age of three? I think it is D0145, but unsure if D0150 is an option? This would be the first exam in our office and the patient is not in pain.

Admin November 4, 2014 12:24 pm

The most appropriate exam code for a child under the age of 3 would be D0145. The exam code D0150 would not be appropriate and should not be used in this instance.

asked 11 years ago by

ADCA Admin

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doctor does the following: two samples were procured with separate 2.0mm biopsy punches. A local was also used. Medical codes are 11100 and 11101 and transfer to D7286. Do I charge this code twice for each biopsy?

Admin October 30, 2014 11:31 am

Yes, you would get D7286 twice provided the were not in the same area or site.

asked 11 years ago by

ADCA Admin

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When billing for implants, do you include the abudment placement as part of D6010, or do you bill the abudment separately when it is placed D6057?

Admin October 28, 2014 2:13 pm

Billing for implants is the same as billing for a crown or bridge. Without seeing the providers notes if a single crown is supported by an abutment you may consider using D6058-D6094 instead.

asked 11 years ago by

ADCA Admin

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Is there a specific ADA code for a diagnostic wax up?

Admin October 21, 2014 1:26 pm

This is considered the same as a diagnostic casts(study models, diagnostic models), in essence it is a working mold. Therefore, the appropriate code would be D0470

asked 11 years ago by

ADCA Admin

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Are there any good reference materials you could suggest for helping answer questions pertaining to billing of implants and abudments, bone grafting, materials used for bone grafting and implants?

Admin October 16, 2014 7:47 am

The ADCA is coming out with an Oral Surgery specific course that will assist with coding and billing dental implants. This course is set to be released January 20, 2015. In the meantime you may check with Glidewell Dental Lab as they offer a course on billing dental implants.

asked 11 years ago by

ADCA Admin

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When billing for TMJ splints, can you bill them on the order date, or do you have to bill them when dispensed to the patient.

Admin October 16, 2014 7:45 am

This is carrier specific and you will need to check with each individual carrier guidelines. However according to Delta Dental Utilization Review the rule of thumb is to bill on the delivery date.

asked 11 years ago by

ADCA Admin

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For bone grafting for the purpose of implant placement, our oral surgeon uses a couple different types of material for the grafting, a membrane. To code this and bill to insurance, I am using D6104, D4265 and D4266 for billing. Is this correct or should all charges be simply billed under only the D6104?

Admin October 16, 2014 7:04 am

The only code that should be billed for the service you described above would be D6104.

asked 11 years ago by

ADCA Admin

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I have a question. I have providers in my peds specialty that want to bill a D1206 Varnish with a regular preventive exam. Can they with the D code? And/or is there a comparable code in CPT?, And would they be reimbursed for it? and what are the RVUs associated with this code?? Thank you so much, cheers, Emily Heed CPC, CDC-A

Admin September 27, 2014 12:04 pm

Yes they may bill the D code to medical as there is no compatiable CPT code for fluoride varnish. As for reimbursment of this procedure to medical providers there is no statistical data to prove one way or the other as of yet. It is completely upto the individual carriers.

asked 11 years ago by

ADCA Admin

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I work at a hospital based dental clinic which also has a dental residency program. We are switching from the hospital billing system to Softdent on Monday September 15. During training it came to our attention that the claim forms are generated from the schedule in Softdent. Our current procedure for claims is that all the residents and hygienists are billed under our program director and claims are sent out under his NPI # and license #. With the way Softdent is set up we can have a "billing provider" and a "treating provider". Our problem is that the residents do not have license numbers but they do have NPI numbers. The hygienists have license numbers but no NPI numbers. The ADA claim form has those fields under the treating provider section. Is it ok to have the resident/hygienist listed on the claim form without having a license number or NPI? I hope you can help us solve this problem as we are going live with the new software on Monday. Thank you for your time and assistance.

Admin September 11, 2014 1:49 pm

The appropriate way to submit the claim would be to have the attending provider’s information in box 45-52a and the treating/resident/hygienist information placed in box 53-58 of the ADA 2012 claim form. You may submit the claim with the hygienist or residents NPI number only as long as the attending has both NPI and license (more)

asked 11 years ago by

ADCA Admin

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