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Hi
I am billing CPT code D7880 ( it has been approved) is there a modifier I should use with this code?
Thanks
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Hi guest!
There is no standard modifier to use for D7880 when billing for TMD appliances.
Hope this helps!
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Rank: Guest
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Hi Courtney,
Im still having trouble billing D7880 to BCBS of Illonios, or any other medical insurance for that fact. The minute they see the (D) its denied. I changed the code to 21085 but now they are asking for a modifier. The rep has suggested (51,52, or 59) but I was told those are only used for surgical procedures, and of course this is non-surgical. She also recommended possibly submitting for (DME) with a modifier.
What would you recommend? And with what modifier? All procedures are done in a professional setting at the office.
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi D!
Yes the reports from our clients when having issues with the "D" codes are usually with BCBS's. If you do choose to use 21085, the modifier 52 would really be the only one that would be appropriate that I can think of, because 21085 actually stands: Impression and custom preparation; oral surgical splint
And modifier 52 stands for reduced services. (modifier 51 is for multiple surgeries/procedures, and modifier 59 stands for Distinct Procedural Service).
So, since obviously an appliance for conservative TMD treatment (a "reversible, removable appliance") is not a surgical splint, we do not recommend the use of 21085 to represent a TMD appliance.
Many practices we work with have reported success with 21299, 21499 or E1399 in certain cases when the medical insurer will not accept D7880 or D7899. In a very few selected cases a practice has been instructed by the medical insurer to use 21089. There is not a standard modifier to use I am aware of.
Hope this helps!
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Rank: Guest
Joined: 9/8/2012(UTC)
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Thank you Courtney! I will try that. You're the best!!!
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