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Guest
#1 Posted : Tuesday, November 21, 2017 1:03:48 PM(UTC)
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Guest

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I was under the impression that Medical Carriers must honor the code D7240 as a valid HCPCS code on a medical claim form. Blue Card is making me change it to use the medical code 41899 for a miscellaneous surgical code and write in the D7240 next to each tooth #. Is this legal for them to make us change the code to miscellaneous when the D7240 states exactly what we are doing? I have also included the diagnosis code K01.1. We've tried this with them in the past and it denied stating we needed a valid cpt code! I'm so confused.

Thanks for any help or clarification!
Jennifer
courtneydsnow
#2 Posted : Wednesday, November 22, 2017 5:15:59 PM(UTC)
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courtneydsnow

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Hi Jennifer!

It is certainly not uncommon for a medical insurer to prefer the use 41899 in place of a "D" code on the medical claim. While many medical insurer will process D7240 (removal of impacted tooth - completely bony) since there is a not a direct CPT crosscode, not all will.

Tooth numbers can be easily reported on the medical claim using the JP qualifier.

41899 is not necessarily a surgical CPT code, it actually stands for: Unlisted procedure, dentoalveolar structures

Here is some additional information about the JO and JP qualifiers:

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-v5.pdf


Hope this helps!
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