Ask the Coder (163)

Hi! I would recommend sending a pre and post-operative x-ray of the tooth, the clinical notes showing the Doctor's diagnosis, and a narrative from the provider stating why they determined that the best care for the patient was a D2954.

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).

You're stating that the insurance downcoded the procedure based upon the evidence of the perio chart? It would depend on if you are in network or out of network with the insurance company as to how they process the difference when they downcode the procedure. If you are in network, it's likely that they process (more)

No

The code for the sectioning of the bridge is D9120 and depending on the type of extraction performed it is either D7140 or D7210

What is code 4300