We are having trouble receiving payment on some of our dental procedures. Delta Dental is one of the dental insurance companies. They require dental codes. Is that correct for us as a medical provider billing for the anesthesia services to bill a dental code on a 1500 claim form? It makes me nervous that delta dental is telling us we need to change our code in order to receive payment. Has anyone else having this problem? I really appreciate your advice/guidance. : )
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Wiki Dental Procedure
- Thread starter breanne
- Start date
Michele Hannon
Guest
Delta is purely dental......no medical. The dental codes for Conscious Sedation are:
D9241 first 30 minutes of IV Conscious Sedation
D9242 additional 15 minutes of IV Conscious Sedation.
Anesthesia providers don't typically bill D codes. The ASA code (anesthesia code) for anesthesia for oral surgery (MAC or general anesthesia) is 00170.
Is the anesthesia provider administering anesthesia in the oral surgery office, ASC or hospital?
D9241 first 30 minutes of IV Conscious Sedation
D9242 additional 15 minutes of IV Conscious Sedation.
Anesthesia providers don't typically bill D codes. The ASA code (anesthesia code) for anesthesia for oral surgery (MAC or general anesthesia) is 00170.
Is the anesthesia provider administering anesthesia in the oral surgery office, ASC or hospital?
Thank you Michele for your reply
We bill for the anesthesia provided at the Surgical Center. So it is an outpatient facility. The patients call us after contacting Delta Dental and tell us we need to change our procedure code to the dental codes for them to pay our claim. Is that the right thing to do? We are not billing for the dental services just the anesthesia provided. We do bill the 00170 on the cases.
Thank-you for your help, I really appreciate it.
Breanne Woolsey CPC, CPC-H
We bill for the anesthesia provided at the Surgical Center. So it is an outpatient facility. The patients call us after contacting Delta Dental and tell us we need to change our procedure code to the dental codes for them to pay our claim. Is that the right thing to do? We are not billing for the dental services just the anesthesia provided. We do bill the 00170 on the cases.
Thank-you for your help, I really appreciate it.
Breanne Woolsey CPC, CPC-H
Michele Hannon
Guest
Typically, Delta will not pay for anesthesia outside of the oral surgery/dentist office.
After researching, I did find the following (from the AAOMS).......
USING DENTAL CODES ON MEDICAL CLAIMS
In general, CPT codes are not used on ADA forms, and CDT codes are not used on CMS 1500
(Medical) forms. However, some medical carriers may direct that you use CDT codes on a
CMS 1500 form for “dental” procedures which do not have an applicable CPT code
(e.g. third molars). In those situations, they may also request use of CDT anesthesia codes.
The presence of an anesthesia code, or any procedure code, does not guarantee payment for these services. It is crucial for the OMS practitioner and his/her staff to understand the intricacies of reimbursement for anesthesia services by each carrier, managed care organization, and Medicare.(end)
Unless the patient has an oral surgery rider on their medical policy, it is my experience that anesthesia is usually not covered out of the oral surgery office.
After researching, I did find the following (from the AAOMS).......
USING DENTAL CODES ON MEDICAL CLAIMS
In general, CPT codes are not used on ADA forms, and CDT codes are not used on CMS 1500
(Medical) forms. However, some medical carriers may direct that you use CDT codes on a
CMS 1500 form for “dental” procedures which do not have an applicable CPT code
(e.g. third molars). In those situations, they may also request use of CDT anesthesia codes.
The presence of an anesthesia code, or any procedure code, does not guarantee payment for these services. It is crucial for the OMS practitioner and his/her staff to understand the intricacies of reimbursement for anesthesia services by each carrier, managed care organization, and Medicare.(end)
Unless the patient has an oral surgery rider on their medical policy, it is my experience that anesthesia is usually not covered out of the oral surgery office.