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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.

Admin 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)

asked 14 years ago by

ADCA Admin

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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!

Admin 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.

asked 14 years ago by

ADCA Admin

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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.

Admin 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)

asked 14 years ago by

ADCA Admin

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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.

Admin January 4, 2012 1:34 pm

Size does not matter it is the picture being taken that matters.

asked 14 years ago by

ADCA Admin

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When charging for Biologic Materials, is it done per tooth, quadrant, or site?

Admin 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.

asked 14 years ago by

ADCA Admin

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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?

Admin 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.

asked 14 years ago by

ADCA Admin

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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.

Admin December 20, 2011 9:45 am

D4211

asked 14 years ago by

ADCA Admin

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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?

Admin December 17, 2011 1:28 pm

No, you must adhere to the contractual obligation set forth by the insurance carrier.

asked 14 years ago by

ADCA Admin

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What can be done when two insurances are claiming to be secondary? I have called numerous times to both insurance companies and neither wants to budge, I have had the subscriber call and is getting the same result. Any suggestion welcome

Admin December 15, 2011 1:05 pm

You need to find out a few details first. If the patient is the subscriber of both plans; the plan that has been effective the longest is primary. You will need to send eligiblity reports showing the carrier who has been effective longer both eligiblity reports. If the patient is the subscriber on one and (more)

asked 14 years ago by

ADCA Admin

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I have a dentist that would like all new patients to receive a D1110 before exam and x-rays are taken or perio charted. Our concern is that if after patient has exam and x-ray and perio chart, patient needs D4341/ D4342 wouldnt it be questionable one why did a D1110. I have told her about D4355 but refuses to use code stating patients dont need D4355.We have 5 dentist in total 4 disagree with her, so now its has fallen on me , stating that it is an insurnace issue. As far as I am concern we dont let insurance dictate treatment but again how do we justify a doing a D1110 and a week later D4341/D4342.

Admin December 14, 2011 10:11 am

It is not a good idea to take x-rays after a cleaning (D1110) for the fact you just stated above. If a patient has moderate to severe plaque/claculus you want it visible on the x-ray. In order to bill root planning/scaling D4341/D4342 you need to the following; 1. Indications of moderate to severe calculus 2. (more)

asked 14 years ago by

ADCA Admin

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