Ask the Coder (544)

Each carrier has there own set criteria, however, in general the following must be present. 1. pocket depths must be 4mm-5mm or higher 2. Bleeding must be present 3. Gross plaque and/or calculus present 4. Either periodontal surgery was performed or full mouth debridement prior to RPS

Generally speaking they must bill under the supervision of a dentist. There are some procedures they may perform without the presence of a dentist such as routine cleanings, and x-rays. However the x-rays MUST be read by a dentist.

Medicare has a handbook on correct billing guidelines for dental procedures: http://cms.hhs.gov/site-search/search-results.html?q=billing%20for%20manual%20for%20dental Article 140

The most appropriate code would be D7970

The code D2751 includes the crown prep, anesthetic, temporary crown and permanent crown. It does not include a crown build up, crown lenthening, or pins...these are billable seperately.

Yes, this would be considered a core build-up...D2950

Yes, removal of root tips and the removal of a benign odontogenic cyst is billable in the same day.

If the filling is a final resotration you would use code D2391

The 72 hour period starts when your exam is released.

Yes, you may make a correction on the claim form in the remarks area stating "Claim Correction" and refile with code D1352.