Blue Card refusing to process D7240 on medical claim form

[Jeremy Hobbs]

Blue Cross states they can’t enter in to data base the HCPCS code D7240

[niermanpm]

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

[niermanpm]

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: Hope this helps!

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