Ask the Coder (563)

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)

The best narrative to submit is the one the provider wrote in the chart as to why the patient needed nitrous oxide CDT code D9230. If nitrous was used in behavior management it should be accompanied with code D9920, below is an explanation of when behavioral management should be used. D9920 is to be used (more)

Yes

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)

Please be more specific in your question, as there is no current code for intraoral scan. What type of scan and why is it being preformed? Example intraoral cancer scan/screening ?

I found this on the webpage: https://www.dentalclaimsupport.com/blog/examining-cdt-code-d2940-do-you-place-protective-restorations-at-the-emergency-appointment#:~:text=The%20nomenclature%20defines%20D2940%20as%20a%20protective%20restoration.,outside%20the%20mouth%20then%20placed%20on%20the%20tooth This type of restoration is accurately documented and reported to the payer using code D2940 which was revised a few years ago. The previous code nomenclature defined this code as a sedative filling. The current code language includes a revised nomenclature and a descriptor. D2940 protective restoration Direct (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)

You're stating that the insurance downcoded the procedure based upon the evidence of the perio chart? It would depend on if you are in network or out of network with the insurance company as to how they process the difference when they downcode the procedure. If you are in network, it's likely that they process (more)

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)

A prophy should not be billed out on the same day as scaling and root planing. The SRP should be preformed and a week or two later the patient should return for a prophy.