Ask the Coder (563)

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Any patient who has not been seen by any provider in the same practice in over 3 years is considered a new patient.

Coding guidelines state 14-22 periapical films including bitewings must be present however, some insurance companies are paying out an FMX when a pano and bitewings are taken. The best course of action is to appeal the claim stating 14-22 films were not present at this visit.

2016 books are required for all 2016 exams.

It is not common practice to code D0120 with treatment, this is used for 6 month check-up. You are to use D0140 or D0170 for exams with treatment as long as the documentation supports an exam at the same time.

D0140

If you had to re-cement or re-bond the space maintainer the code would be D1550. If you had to place a new space maintainer the code would be D1999 accompanied by a brief narrative as to why the space maintainer had to be replaced.

70355 the diagnosis code would depend on the findings example why are the extractions being performed...impacted teeth, decay, etc.

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Since this was a restorative material failure and it was composite and codes only exist for crown, inlay, onlay, and veneer the most appropriate code would be D2999 with a brief narrative to accompany the claim.