Wiki Dental coding help asap

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vmounce

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I work in an outpatient surgery center. Medicaid has recently changed and have split into 3 Managed Care Organizations. In the past someone over Medicaid told our biller to code dental procedures as D0150. (example: dental extractions) But since the change we are no longer getting paid for D0150. What cpt code can we bill and get paid for these? They are saying to use codes like D9220 and 00170.

I appreciate any information on this.

Vickie Mounce
 
I was told that we can not use dental codes. Anyone have any information regarding doing dental surgeries in an outpatient facility?

I appreciate any ino.

Vickie
 
You might want to review your HCPCS Level II book under the Dental Procedures D0000-D9999. D0150 is a comprehensive oral evaluation. For extractions look at d7000 area. Hope this helps.
 
vmounce said:
I work in an outpatient surgery center. Medicaid has recently changed and have split into 3 Managed Care Organizations. In the past someone over Medicaid told our biller to code dental procedures as D0150. (example: dental extractions) But since the change we are no longer getting paid for D0150. What cpt code can we bill and get paid for these? They are saying to use codes like D9220 and 00170.

I appreciate any information on this.

Vickie Mounce
Click to expand...

Where are you at? (What state?)
 
I would say she is in Kentucky since I also live here & we recently had our Medicaid split into 3 organizations. I do not work in an outpatient facility setting but we use the D codes from the HCPCS book. They are essentially the same as the ones in the CDT. The extraction codes are D7140 - D7241. I'm not sure if it is the same for outpatient facilities, but in an office setting, we must bill these codes to the dental side of each company.

Sorry I can't be of more assistance but I hope this helps a little!

Jennifer, CPC
 
jenndeshon said:
I would say she is in Kentucky since I also live here & we recently had our Medicaid split into 3 organizations. I do not work in an outpatient facility setting but we use the D codes from the HCPCS book. They are essentially the same as the ones in the CDT. The extraction codes are D7140 - D7241. I'm not sure if it is the same for outpatient facilities, but in an office setting, we must bill these codes to the dental side of each company.

Sorry I can't be of more assistance but I hope this helps a little!

Jennifer, CPC
Click to expand...

That makes sense - good advice, too. You can only bill codes from code sets that are accepted by the payer, regardless of what type of service it is. So, if all they recognize for outpatient MD services, are CPT, ICD-9, and HCPCS, you're limited to using those codes. It's not uncommon for plans to require that dental claims be submitted under a (separate) dental benefit plan, in which case I imagine that HCPCS or CDT would probably be acceptable (just guessing, though - I don't have any firsthand knowledge of that). My advice would be to just call the payer, and ask them:
1. If this is even a payable benefit, regardless of how it's coded, and
2. Where you can find information for providers on what codes are covered in regard to this service, or if they have any preferences in how the services are reported to them (if they're reported to the health plan, at all). Most Medicaid plans have separate dental benefits, BTW, so it may be difficult for you to get this service reimbursed, if you're not able to submit claims to them.
Good luck! ;)
 
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Dental Code

Hello,

I bill code 41899 to Medicaid, and we get paid for this code. I have never used dental codes, they are not payable for an ambulatory surgery center.

Diane
CASCC
 
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