Ask the Coder (564)

Hi! This varies per insurance company. I do have a few questions in order to be able to answer a bit more in detail: On the date that you called for benefits on the D2954, was the question specifically asked if the crown would be covered if done on a separate DOS than the D2954 (more)

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.

Depending how old the child is the bitewing could also be D0272

Hello! This is a great question. For D4910, each insurance plan is different. If the patient has coverage for D4910, typically, the insurance will want the date of the initial scaling and root planing along with x-rays and perio charting less than 12 months old. When it comes to the perio maintenance frequency, that also (more)

Hi! In past offices, we have used code D9310: Consultation - Diagnostic service provided by dentist or physician other than requesting dentist or physician.

i did submitted with d7240 with diagnostic code K01.1 still medical ins denied due to invalid/ missing diagnosis code what code i am missing, please help me

It depends on your contract with the insurance company. If the EOB states you can charge the difference, then you can. If it does not, then you cannot. Most insurances will let you charge the difference of the MAC of the submitted charge and the payment of the downgraded code. But if you are in (more)

The American Dental Association has said it's a matter of clinical judgement of the dentist. It is appropriately reported as D4910, but if the treating dentist determines the patient can be treated with routine prophylaxis, then D1110 may be appropriate.

What is the secondary changed their fees/policy? If 100 allowed, primary paid 80, then I would transfer the $20 to the secondary, let the secondary adjudicate then make my adjustments. I am not saying balance bill. The primary allowed 100, I would transfer up to that just like EOB says to secondary. You could be (more)

Agree with prior post, dentist do not usually charge a lab fee. BE careful charging more than the allowed amount on contracted plans and covered services; that is a compliance no no.