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Hi there, a patient was born with a cleft palate and is interesting in improving her smile.. we'd look to do ortho and ant. bridge post ortho to achieve desired results
the codes we will use will be:
D8090
D6740
D6245
D2740
How do you suggest we cross code to submit a medical pre-authorization?
Thank you
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest!
First thing you will need for a pre-auth request is diagnosis code(s), here are some options for you below:
Q35.1 - Cleft hard palate
Q35.3 - Cleft soft palate
Q35.5 - Cleft hard palate with cleft soft palate
Q36.0 - Cleft lip, bilateral
Q36.1 - Cleft lip, median
Q36.9 - Cleft lip, unilateral
As for the procedure codes:
D8090 - Comprehensive orthodontic treatment of the adult dentition
D6740 - retainer crown - porcelain/ceramic
D6245 - pontic - porcelain/ceramic
D2740 - crown - porcelain/ceramic substrate
There are not a direct crosscodes we are aware of for these procedures, so you can either use the "D" code on the pre-authorization request/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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