Wiki medicare and dental dx

[bstroyick]

We are a FQHC. I have a patient that had an appointment for htn but when seen had the f/u of htn and also tooth pain. The provider billed the ov with dx htn and also the dental dx. Medicare does not cover any dental. We did treat the dental pain with antibiotics. Would it be ethical or correct billing if I split the claim with one ov with htn and the other ov with mod 25 99211 with the dental dx? However if I do so the 99211 will not go out the door so medicare will not even see the dental. Is that considered not reporting? Should I do this? Is this ethical?

 

[mitchellde]

No you cannot split this claim just because the dental dx is non covered. You will bill with the HTN first listed and the pain secondary. It will either be covered or not.

 

[ckeeney]

I agree you cannot split the claim however, when I worked for an FQHC our Medicare biller was able to successfully appeal a dental dx for pain due to infection and the required medical treatment (i.e. antibiotics). You may have to submit the chart note. It is worth trying if the visit is denied because of the dental diagnosis.

 

[bstroyick]

thanks. I feel the same way yall do. I posted question for my managers. I did submit an appeal with all notes to see if they will pay.