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Hi Guest! There is no standard modifier i am aware of for this combination of services. Modifiers are 2-character codes that you basically add on to procedure and equipment codes in medical billing, on the medical claim CMS1500 in field 24 D. Modifiers provide additional information regarding the service or equipment to the medical insurer. For example, a standard modifier to use when billing medical insurance for a custom made oral appliance for Obstructive Sleep Apnea (OSA)(HCPCS code E0486) is the modifier "NU", which stands for "new equipment". You may consider using the JP qualifier to indicate the tooth number(s) being extracted. The JO & JP qualifiers represent tooth numbers and areas of the oral cavity for medical claims. The following are the codes for tooth numbers, reported with the JP qualifier: • 1 –32: Permanent dentition • 51 –82: Permanent supernumerary dentition • A –T: Primary dentition • AS –TS: Primary supernumerary dentition The following are the codes for areas of the oral cavity, reported with the JO qualifier: • 00 : Entire oral cavity • 01 : Maxillary arch • 02 : Mandibular arch • 10 : Upper right quadrant • 20 : Upper left quadrant • 30 : Lower left quadrant • 40: Lower right quadrant Examples of how this would look on the medical claim can be found in the NUCC's CMS 1500 claim form manual here, starting on page 46 & 47: http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v5.pdfHope this helps!
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Would I need a modifier as well? I am not even sure what a modifier is to be honest.
Thanks
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Hi guest!
Ok great, here are some coding options for you based on what you described:
K12.2 - Cellulitis and abscess of mouth K04.6 - Periapical abscess with sinus K04.7 - Periapical abscess without sinus K04.1 - Necrosis of pulp K04.2 - Pulp degeneration K04.01 - Reversible pulpitis K04.02 - Irreversible pulpitis
• K05.211 - Aggressive periodontitis, localized, slight • K05.212 - Aggressive periodontitis, localized, moderate • K05.213 - Aggressive periodontitis, localized, severe • K05.219 - Aggressive periodontitis, localized, unspecified severity • K05.221 - Aggressive periodontitis, generalized, slight • K05.222 - Aggressive periodontitis, generalized, moderate • K05.223 - Aggressive periodontitis, generalized, severe • K05.229 - Aggressive periodontitis, generalized, unspecified severity • K05.311 - Chronic periodontitis, localized, slight • K05.312 - Chronic periodontitis, localized, moderate • K05.313 - Chronic periodontitis, localized, severe • K05.319 - Chronic periodontitis, localized, unspecified severity • K05.321 - Chronic periodontitis, generalized, slight • K05.322 - Chronic periodontitis, generalized, moderate • K05.323 - Chronic periodontitis, generalized, severe • K05.329 - Chronic periodontitis, generalized, unspecified severity • K05.10 - Chronic gingivitis, plaque induced • K05.11 - Chronic gingivitis, non-plaque induced • K02.3 - Arrested dental caries • K02.51 - Dental caries on pit and fissure surface limited to enamel • K02.52 - Dental caries on pit and fissure surface penetrating into dentin • K02.53 - Dental caries on pit and fissure surface penetrating into pulp • K02.61 - Dental caries on smooth surface limited to enamel • K02.62 - Dental caries on smooth surface penetrating into dentin • K02.63 - Dental caries on smooth surface penetrating into pulp • K02.7 - Dental root caries • K02.9 - Dental caries, unspecified
Hope this helps!
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We extracted the tooth due to infection of the gums surrounding the tooth. Bacteria became trapped under the flap and caused swelling and irritation.
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Hi Guest!
D0220 - intraoral - periapical first radiographic image can be cross coded to: 70300 - Radiologic examination, teeth; single view
D9230 - inhalation of nitrous oxide / anxiolysis, analgesia can be crosscoded to: 00170 - Anesthesia for intraoral procedures, including biopsy; not otherwise specified
D7220 - Removal of impacted tooth - soft tissue
there is actually not direct crosscodes we are aware of for extractions, so you can either bill the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), or you can use the CPT code below and include a narrative report describing the procedure: 41899 - Unlisted procedure, dentoalveolar structures
As for the ICD-10 diagnosis code(s) - that will depend on the patient's condition, or basically, why are you doing these services? (if you can give me some additional details surrounding that I am happy to offer you some coding options).
Hope this helps!
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I need help with filling a medical claim thru BCBS LA for dental. How do I convert the following codes to the CPT/HCPCS and what would I put for the Diagnosis (#21 on medical claim).
D7220-Removal imp. Tooth Soft D0220-Pericapical single, first D9230-N20 Analgesia
Thanks
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