Ask the Coder (559)

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.

D0171

The claim should be submitted to secondary insurance even if there is a remaining balance. It's crucial to ensure that the patient's primary and secondary insurance records accurately reflect their procedure history.

Hello! The patient's secondary insurance always needs to be billed to ensure accurate procedure history, regardless of the amount of the primary insurance's payment. Hope this helps!!

This is considered the same as a diagnostic. Therefore, the appropriate code would be D0470

I think yes he can charge you. D9310 is consultaion- diagnostic service provided by dentist or physician other than requesting dentist or physician. It means a patient encounter with a practitioner whose option or advice regarding evaluation and or management of a specific problem may be requested by another practitioner. The consultation includes an oral (more)