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    Hello this is a Medicaid dental billing question NY State.Taking a new patient in to the dental office and seeing the new patient for the first visit and the hygienist doing D1110 or D1120 and any necessary x-rays depending on age and then having the patient come back for the next appointment to sit down with the dentist for the complete intial examination code here age dependant and treatment plan. Is this acceptable dental Medicaid billing practice or should this all be done at one appointment is there a right or wrong here?
    February 10, 2012 5:32 am
    According to NY State Medicaid Dental Procedures and Code Guidelines, it does not state that an exam and cleaning must be preformed on the same visit. However, in most instances it is preferable to have the cleaning, exam and x-ray performed at the same time. There is no right or wrong on this particular issue.
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    If you have a new patient that presents to your office and sees the hygienist first and they show signs of periodontal disease and you perform D0180, D0330,and D1110 at the first visit and have the patient come back to see the doctor at the next visit within the next couple of weeks can the doctor then charge D0150 even though the D0180 was just charged.
    February 9, 2012 12:09 pm
    This would not be appropriate as a D0180 covers similiar aspects as a D0150. Having both of these exams performed within a couple of weeks may raise a concern with the insurance carrier. Having said that as long as the documentation is clear, present and the exams are necessary there is no rule stating you (more)
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    What HCPCS code would you bill for a Nasal Alveolar Molding Device or obturator? The DDS is billing the medical procedure as cpt 21080 and ICD-9 749.21. Any help would be greatly appreciated.
    February 7, 2012 8:50 pm
    Your CDT or HCPCS code range would be D5931-D5932 or D5936. D5931 Obturator prosthesis, surgical ( This is used as a temmporary prosthesis during or immediately following surgery and is typically utilized for 6 months to aid in healing.) D5932- Obturator prosthesis, definitive (this is intended for long term use) D5936- Obturator prosthesis, interim (Made (more)
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    I noticed that you have suggested coding appliances (sleep apnea, etc.) using 21089 for the appliance and 99002 for the handling. Per the CPT- 21089 should only be used when the physician actually designs and prepares the prosthesis (no outside lab)while 99002 is used for the handling, fitting & adjustment of an appliance fabricated by an outside lab (submitted with lab fee box 20). These codes are mutually exclusive. Please explain. Thanks!
    January 26, 2012 3:41 am
    Yes, you are correct. This answer was for an office that has a lab in house. If you are sending the impression to an outside lab you will only utilize CPT 99002, however, if you have a lab in house you will utilize 21089. Thank you for your correction.
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    What is the difference between external and internal bleaching per tooth? (D9973-D9974)Also, is there any difference in code between in-office bleaching and take-home tray bleaching? Thank you.
    January 12, 2012 9:24 am
    There are two different methods for external bleaching, the first is to have the dentist take impressions of the patients teeth so that custom trays (specifically for bleaching) can be made. When the trays are completed, you give the trays and a bleaching kit to the patient to take home so that they can bleach (more)
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    When doing the following: D0220, D0230, D0240 does the size of the film matter if the required x-ray is being done? example- D0220 on a larger size film.
    January 4, 2012 1:34 pm
    Size does not matter it is the picture being taken that matters.
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    When charging for Biologic Materials, is it done per tooth, quadrant, or site?
    January 3, 2012 7:28 pm
    This code is carrier driven meaning it is at the carriers discreation as to how they are going to pay. Having said that most carriers allow this code per tooth.
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    Can I code for a 4 or more teeth for periodontal osseous surgery if the actual teeth with pockets are only 3 but extends between 4 or more teeth? For example teeth with 5 mm pockets are #'s 17, 18, 24. Would this be considered 4 or more teeth since the surgeon would need to access over 4 teeth to effectively perform the surgery?
    January 3, 2012 7:20 pm
    You may only code those teeth that are diseased and involved. From your description above it appears to be 1-3 teeth, therefore CDT code D4261 would be the most appropriate code.
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    If the doctor trims some healthy gum tissue to give a crown or bridge more tooth to adhere to, what gingivectomy type code should we use? Thank you.
    December 20, 2011 9:45 am
    D4211
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    If a patient wants a crown fabricated at a lab that is more expensive than the lab usually used for a better cosmetic outcome- can I balance bill the patient for the amount that is not covered by her dental insurance?
    December 17, 2011 1:28 pm
    No, you must adhere to the contractual obligation set forth by the insurance carrier.
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