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Guest
#1 Posted : Thursday, February 16, 2017 8:52:36 PM(UTC)
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Guest

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Patient has severe congenital oligodontia with only 15 permanent teeth. Tooth holding 30 year old bridge failed and implants were installed. Medical insurance covered the first phase of installing the implants but we're having trouble getting the final crown placement approved. We were told all treatment related to the implants would be covered but the pre-authorization ran out after the first phase was completed.

Trying to covert codes:
D6240
D6057
D6069
D9950

to CPT medical codes. Sounds like you would recommend using the generic 21299 with the dental coding. They are insisting on medical codes but can offer no help.

Thank you.

Edited by user Thursday, February 16, 2017 8:54:50 PM(UTC)  | Reason: to clarify description

courtneydsnow
#2 Posted : Friday, February 17, 2017 8:32:07 AM(UTC)
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courtneydsnow

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Hi Guest!

D6240 - pontic - porcelain fused to high noble metal
D6057 - custom fabricated abutment - includes placement
D6069 - abutment supported retainer for porcelain fused to metal FPD (high noble metal)
D9950 - occlusion analysis - mounted case

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), but for the medical insurers who won't accept the "D" codes, you can try the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures

Using the "JO" & "JP" modifiers on the claim form in the red shaded line above the line item may help.

The following are the codes for tooth numbers, reported with the JP qualifier:
• 1 –32: Permanent dentition
• 51 –82: Permanent supernumerary dentition
• A –T: Primary dentition
• AS –TS: Primary supernumerary dentition

The following are the codes for areas of the oral cavity, reported with the JO qualifier:
• 00 : Entire oral cavity
• 01 : Maxillary arch
• 02 : Mandibular arch
• 10 : Upper right quadrant
• 20 : Upper left quadrant
• 30 : Lower left quadrant
• 40: Lower right quadrant

Examples of how this would look on the medical claim can be found in the NUCC's CMS 1500 claim form manual here, starting on page 46 & 47:
http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v4.pdf

Here are instructions to use the JO/JP qualifiers in your DentalWriter software below:

1) In any claim in DentalWriter, double click on any line item in box 24 (or click in any white box in the line item then click the "edit service" button at the bottom of box 24) in which you wish to add the qualifiers.

2) A "procedure or service" window will appear where you can edit information on that line item. Scroll to the bottom of that window to the "supplemental information" field and type in your desired qualifier with the tooth number(s) or area of the oral cavity codes defined above, then click the "save and close" button in the upper left hand corner of the window, shown below:

3) The text you entered will appear in the red shaded line above the dates of service of the line item you selected, shown below:


Additional instructions for use of the JO and JP qualifiers is provided in the CMS 1500 claim form manual:
• When reporting tooth numbers, add in the following order: qualifier, tooth number, e.g., JP16. When reporting an area of the oral cavity, enter in the following order: qualifier, area of oral cavity code, e.g., JO10.
• When reporting multiple tooth numbers for one procedure, add in the following order: qualifier, tooth number, blank space, tooth number, blank space, tooth number, etc., e.g., JP1 16 17 32.
• When reporting multiple tooth numbers for one procedure, the number of units reported in 24G is the number of teeth involved in the procedure.
• When reporting multiple areas of the oral cavity for one procedure, add in the following order: qualifier, oral cavity code, blank space, oral cavity code, etc., e.g., JO10 20.
• When reporting multiple areas of the oral cavity for one procedure, the number of units reported in 24G is the number of areas of the oral cavity involved in the procedure.

Hope this helps!
Guest
#3 Posted : Sunday, February 19, 2017 5:41:20 PM(UTC)
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Guest

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Thank you so much!!
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