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Courtney, thank you so so much! You have helped so much!
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Hi Guest!
Thanks of you for the kind words! We love what we do here.
D9310 - consultation - diagnostic service provided by dentist or physician other than requesting dentist or physician can be crosscoded to a new or established patient evaluation & management (E&M) codes - 99202-99205 (new patients), or 99211-99215 (established patient):
New patients: 99202 – 15-29 mins 99203 – 30-44 mins 99204 – 45-59 mins 99205 – 60-74 mins
Established patients: 99212 – 10-19 mins 99213 – 20-29 mins 99214 – 30-39 mins 99215 – 40-54 mins
D0171 - re-evaluation – post-operative office visit can be crosscoded to an established patient evaluation & management (E&M) code - 99211-99215: 99211 - under 10 minutes 99212 – 10-19 mins 99213 – 20-29 mins 99214 – 30-39 mins 99215 – 40-54 mins
D0383 - Cone beam CT image capture with field of view of both jaws, with or without cranium
There is actually not currently a specific CPT code for Cone Beam CT (CBCT)……the closest CPT code is: “70486 - Computed tomography, maxillofacial area; without contrast material”. Some medical payers state in their policy that 70486 should be used for CBCT, for example, United Healthcare & Evicore state this in their radiology medical coverage policy. However, some medical insurers may perfer a different code when used for CBCT because the description of 70486 does not specify “cone beam”.
So, “76497 - Unlisted computed tomography procedure (eg, diagnostic, interventional)” is an option to use (keep in mind you'll need to provide a narrative description for unlisted codes) We also see practices billing out for "76102 - Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography), other than with urography; bilateral"
D3348 - retreatment of previous root canal therapy - molar D3347 - retreatment of previous root canal therapy - premolar D9999 - unspecified adjunctive procedure, by report
The codes listed above do not have direct crosscodes we are aware of, 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 codes below and include a narrative report describing the procedure: 41899 - Unlisted procedure, dentoalveolar structures
Now, as far as the claim form - if the provider's office is sending the claim on your behalf, they will use the universal medical claim form called the CMS1500. However, when a patient files their own claim, the insurer will typically provide a simplified version intended for patient use. For the invoice: it *should not* matter if the dental codes appear of the invoice. As mentioned, some medical insurers can even process the "D" codes on the claim! But, some won't and require the corresponding CPT codes instead.
Hope this helps!
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Courtney will be able to help you!
All dental/medical offices should be trained in cross coding. The procedure I went through is thousands of dollars. I do not know what Blue Shield will pay, but anything would be helpful!
Best of luck to you!
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This seems like such a great website. Thank you for this information. I, too, like some other posters are completely lost. I asked my providers and they are uncooperative. Like the last poster, Blue Sheild has been really helpful but we can only ask for so much help.
So question: do you use the claim forms on blue shield? also it asks for you to upload invoices, etc. My invoice has dental codes on it, should I ask the provider to invoice me without the dental codes or does it matter to Blue Shield?
D9310-1 Spec Consult
D0383 Full Cone Beam CT Scan
D3348 Molar - Retreatment
D9999 Gentle Wave Procedure&/Laser/Ozone
D3347 Bicuspid - Retreatment
D0171 Post op
Can you help with these? Thank you so so much!
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Thank you so very, very much! You are truly a blessing. I am so grateful for the help and really needed someone that had a knowledgeable (medical/dental) industry answer. Blue Shield assisted me when I submitted for reimbursement of CT Scan, but they are also the payer, so to speak, so having this information is enormously helpful. You are providing a service that I was not aware I even needed before this. I am grateful you are online and most appreciative of these thorough answers. Thank you! Thank you! Thank you!
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Hi m1z!
For the pre-authorization, most medical insurance companies will allow a patient to initial/submit a pre-authorization request if the practice does not do it on behalf of the patient. Unfortunately it is not uncommon for a dental practice to be unfamiliar with working with medical insurers (our software & systems help dental practices with this!). If your dental practice is unable to imitate the pre-authorization for you, you can ask your medical insurer to supply you with a patient's request for pre-authroization. These forms are sometimes available on their website as well!
Typically, in addition to the procedure codes below, they will also ask you for ICD-10 (diagnosis) codes. The diagnosis code(s) used will depend on the condition/symptoms, or in other words, why are the services being rendered! For example, for a shattered tooth, some coding options are: S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture G89.11 - Acute pain due to trauma
But, it all depends on the condition, and if it was accidental injury/trauma, there are even codes to describe how it happened! For example, W00.0XXA stands for: Fall on same level due to ice and snow, initial encounter). If you'd like to provide me some additional details about the condition, I'm happy to offer you some coding options.
As for the procedure codes you listed:
D7953 - bone replacement graft for ridge preservation - per site Can be cross coded to: 21210 - Graft, bone; nasal, maxillary or malar areas (includes obtaining graft) 21215 - Graft, bone; mandible (includes obtaining graft) **use modifier -52 for reduced services when bone is not obtained from patient
D7951 - sinus augmentation with bone or bone substitutes via a lateral open approach can be crosscoded to: 21210 - graft, bone; nasal, maxillary, or malar areas *use -52 modifier for reduced services when bone is not obtained from the patient
D6010 - surgical placement of implant body: endosteal implant can be cross coded to: 21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3 or less)
D7210 - Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated
Extractions actually do not have direct crosscode - 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
Hope this helps!
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Hi Courtney,
I posted this earlier today but thought I would reply to this other poster in hopes you would see and answer.
I shattered a tooth, it needed to be extracted, then received a bone graft, then finally implant placement with bone graft.
I spoke to my major medical, Blue Shield and they asked about pre-authorization. Who can help me with that? The periodontist's office? I hope not. They have been extremely uncooperative, but if that is the case, then so be it.
My dental codes are below. If you could offer any additional information you think I might need, it would be very helpful!
Codes are:
D7210 D7953 D7951 D6010
Thank you!
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Hi Guest!
D6793 - provisional retainer crown - further treatment or completion of diagnosis necessary prior to final impression D6752 - Retainer crown - porcelain fused to noble metal D6242 - Pontic – porcelain fused to noble metal D2335 - resin-based composite - four or more surfaces or involving incisal angle (anterior)
There are not direct crosscodes we are aware of for these services, 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
Hope this helps!
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Below are the following dental procedure codes. I need to turned those dental codes into medical codes, so that i can be reimbursed. Any help would be appreciated
D6793 D6752 D6242 D2335
Thanks
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