Ask the Coder (539)

Hi! I would recommend sending a pre and post-operative x-ray of the tooth, the clinical notes showing the Doctor's diagnosis, and a narrative from the provider stating why they determined that the best care for the patient was a D2954.

The first question you need to ask would be "Why is an Endodontist performing a 6 month check-up?" If it is to check the status of a RCT performed on a patient, this is typically considered inclusive. None-the-less, since there is no specific examination code for a 6 month check-up from an Endodontist and no (more)

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

No it is not considered bilateral...however you would have two codes one for the maxillary and one for the mandibular. If the jaw sugery was performed on both upper and lower, right and left sides then you would have a bilateral upper and lower jaw surgery.

All CDT codes will require ICD-9-CM codes to accompany them on the claim.

Yes, anytime x-rays are taken they should be charged out so the insurance company is able to keep track of procedures performed on the patient.

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Depending on the diagnosis code you used their may be repercussions to the patient (i.e. if you placed a diagnosis of malignancy and it was benign) Once the claim is processed you will need to immediately put in for a claim correction with Medicare, they will usually ask you to use one of the forms (more)