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Hello Robin,
Thank you for your question on our forum and to answer your question...
You are correct in thinking that the DNA appliance does not meet the criteria needed to code E0486. However this is somthing this can always change. Criteria and appliances are changing on a daily basis in this profession.
You are also correct in thinking that the S8262 code is suggested for an orthotic for TMD therapy. However we have seen success with it when billing for OSA. Keep in mind the important code to focus on is OSA (Obstructive Sleep Apnea) and the fact that dentists can not diagnose it so having the diagnosed sleep study is a must. There are about 100 FDA approved appliances that meet the sleep apnea criteria and I am cofident the DNA appliance will meet that criteria soon.
In the event of an audit they may want to have the FDA approval code of the appliance you used showing it meets the critera. We have on many cases seen the insurance company request this upon billing and processing.
There are some unspecified codes that have been tried however we have not seen much success billing with an upspecified code. All of the above coding should accompany a letter of medical necessity, medical history, SOAP information,other therapy attempts and order for the oral appliance. These are all provided with in DentalWriter.
Hopefully this was helpful.
Thank you!
Glennine
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Rose, can you please let me know if this code is correct for the appliance we are using:
If we have patients with OSA but they have decided to start treatment using the "DNA" appliance, we have been using E0486 but from the guidelines I've read, since the DNA has to be adjusted each 4 weeks for a period of 18-24 or more months, it does not qualify for E0486. I have searched thru HCPCs books, CPT books, online, etc..................I can only find 2 other codes to be used:
one is A9270 which is usually a non-covered charge
and S8262 - but from what I understand of this code, it's used in the treatment of TMJ.
Most of our patients do not have a TMJ/TMD diagnosis, but they have an OSA diagnosis but want the long term benefits that the DNA appliance offers.
We don't want to get caught up in any kind of audit for using E0486 in a situation for the DNA appliance.
any suggestions?
thanks,
Robin Pichelmayer
Emerald Coast Dental Sleep Medicine
Panama City Beach, FL
850-249-9331
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