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    Hi, we billed a D2394 for #28 for surfaces MODB and claim was denied for invalid surfaces. The CDT does not specify what surfaces are billable with this code. Is there a way to know which surfaces are valid for D2394?
    November 6, 2014 9:50 am
    Every carrier is different, however, we suggest you appeal the claim as MODB on a posterior composite would be appropriate.
    Admin
    asked 11 years ago by
    ADCA Admin
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    I work in a multi provider office. If one of our dentists refers to another dentist inside our organization for treatment such as a crown or Root canal treatment and a consultation is necessary to determine if the dentist can perform the treatment, what code do I use? This would mean that the dentist that is possible agreeing to perform the treatment wishes to clinically exam the area before scheduling the treatment. Does a code exist for this type of exam?
    November 4, 2014 12:32 pm
    The appropriate code for a consultation performed by two seperate providers of the same office would be D0160.
    Admin
    asked 11 years ago by
    ADCA Admin
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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.
    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.
    Admin
    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.
    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.
    Admin
    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?
    October 30, 2014 11:31 am
    Yes, you would get D7286 twice provided the were not in the same area or site.
    Admin
    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?
    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.
    Admin
    asked 11 years ago by
    ADCA Admin
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    Is there a specific ADA code for a diagnostic wax up?
    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
    Admin
    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?
    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.
    Admin
    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.
    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.
    Admin
    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?
    October 16, 2014 7:04 am
    The only code that should be billed for the service you described above would be D6104.
    Admin
    asked 11 years ago by
    ADCA Admin
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