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I am not sure if you can help with this question but thought I would try. The example I have is a patient who has 4 wisdom teeth, which two of them are surgical extraction D7210 & 2 are complete bony impactions D7240. The patient needs one hour of anesthesia, D9223. Lets say the medical plan is only covering 30 minutes of anesthesia. However, we do not want to do two different surgeries. Can we divide the 1 hour anesthesia time between the dental & medical when we bill? For example submit 30 minutes of anesthesia to the dental insurance with the surgical extractions & 30 minutes of anesthesia to the medical insurance. Is this legal? Or does the whole hour, 4 units, have to go to one insurance company. I would appreciate any feedback. Lori
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Hi Lori!
My suggestion for this situation would be to bill all 4 units to the medical first, and then once the claim has been processed and you have an EOB from the medical claim, file the remaining balance to the dental as secondary with a copy of the EOB from medical.
I don't think it would be an issue to split them between the two insurers because you are not billing the exact same service to both at the same time (that would definitely be an issue!), however it could be easily misconstrued as double billing the same service.
Hope this helps, have a great day!
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