Ask the Coder (541)

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Virginia will pay for dentures for adults. It does have to be pre-authorized. Most of the time they are approved.

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This can be reported twice if both upper quadrants are augmented. I would recommend sending documentation to support both the UL and UR quadrants so there is no question as to overbilling the procedure. See Coding Companion 2022, Clinical Coding Scenario #3 on page 215 for verification. This procedure is performed to increase the alveolar (more)

CDT code D9110 is typically inclusive of the extraction and therefor will be rejected when submitted at the same time as an extraction. As for the other code D01240 this code does not exist. If the code you were intending is D0120 that would be an inappropriate code as well, since the patient is coming (more)

In order to bill medical insurance, you would need to contract/use an online company to bill medically or purchase a stack of CMS-1500 forms and complete the forms in your office to send to the insurance company. You would also need to be sure that you have a CPT code book and ICD-10-CM code book (more)

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)

The following article will aide you in determining how to assign medical necessity for patients you believe to be high risk. Please click on the link or copy and paste into your browser: https://www.aapd.org/globalassets/media/policies_guidelines/bp_cariesriskassessment.pdf

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)

This question is to vague please give more detail...