Patient was administered anesthetic, gum tissue was opened, & a burr was used to grind off a piece of tori that was protruding from LR lingual area.
If a patient has periocoronitis on tooth 17 and the dentist burns the flap of skin off, what is the correct code? I say D7971, but the dentist insists that I code it under D7280, since operculectomy is not covered under the patient's insurance (Florida Medicaid). The dentist did not remove any bone, did not make an incision. Who is right?
I have two claims for crowns that have been denied - two separate patients, one insured with MetLife, the other Principal. I have been through one appeal with MetLife and two appeals with Principal. I have never had claims denied for lack of necessity. They were necessary and obviously I did not provide the correct documentation/narrative. I would appreciate any help getting insurance benefits for these two patients. Thank you, Beverly Knight