Ask the Coder (165)

Hi! This varies per insurance company. I do have a few questions in order to be able to answer a bit more in detail: On the date that you called for benefits on the D2954, was the question specifically asked if the crown would be covered if done on a separate DOS than the D2954 (more)

Hi! What extraction code are you billing with the D7285? Sometimes, Delta will bundle D7285 with D7250 and D7210. This denial could potentially be appealed with a detailed narrative written by the provider explaining why the biopsy is necessary and asking that Delta review D7285 under CDT guidelines, because the CDT defines D7285 as a (more)

Unfortunately, I can't exactly explain why a payor would request a tooth surface, but it may be a requirement of the plan for the code. This is probably given to be sure that duplicates are not billed. Also, they are typically subject to a 5–10-year limitation. There can be quite a few limitations to these (more)

Hi, Which are you submitting? The missing tooth or the crowns?

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)

There is not a separate code for toothbrush deplaquing. This service would be included in the prophy code, either D1110 (adult) or D1120 (child).

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)

No