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Hello, I am trying to bill the following to BCBS Medical. I know D7140 crosscodes to 41899 and D7310 crosscodes to 41874 (and to specify quadrant). My question is do I bill the CDT codes to medical or the crosscoded CPT codes? And then how do I do that? What modifiers do I use, do I just add addt”l units if I use the CPT codes and how do I specify quadrant and locations? I”ve been searching for this answer and just coming up empty. I have a bunch of ideas, but not sure what is actually correct. We use Dental Writer, so I thought I could hopefully get some answers here. D7140 tooth # 3 extraction D7140 tooth # 4 extraction D7140 tooth #7 extraction D7140 tooth #10 extraction D7140 tooth # 11 extraction D7140 tooth #24 extraction D7310 Alveloplasty / quad D7310 Alveloplasty / quad ICD 10 Dx: K04.7 and K05.6 Thank you so much!
HI ACS! Absolutely, you have come to the right place! Great questions. Some medical insurers will not accept any “D” codes on the medical claim form, although many do these days. So, your best bet may be to go ahead and use the crosscoded CPT codes to avoid delays in case the insurers is unable to process “D” codes. So, for the example you gave, here is how I would set it up on the medical claim: Put all of the extractions on 1 line item with the fee reflecting all of them, using CPT 41899. In the “supplemental information” area of the line item (the red shaded line that is typically left blank), enter this: ZZextractions JP3 4 7 10 11 24 ZZ means “narrative description to follow”, and “JP” means “tooth number(s)” Now, for the Alveloplasty, go ahead and use 41874 as you mentioned, for the supplemental information on this one, you”ll instead of the “JO” qualifiers and use these numbers to indicate the quadrant: 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 46-48: As for modifiers, if these procedures were done on the same date of service, you will want to append modifier 51 (multiple surgeries/procedures) to the lesser expensive of the two line items. If you have any questions or would like some assistance in DentalWriter getting this done, please feel free to reach out to us at training@dentalwriter.com and we are happy to help!
Hi Guest! Yes if the dentures are on the same date of service as other procedures/services, you can use modifier 51. If it is a different date of service, there is no standard modifier to use. And yes you”re correct, for: D5130 – immediate denture maxillary D5140 – immediate denture – mandibular The codes listed above do not have direct crosscodes we are aware of, so you can either bill the “D” code on the medical claim (many insurers these days will process “D” codes when they are medically necessary services), or you can try the CPT code below and include a narrative report describing the procedure: 41899 – Unlisted procedure, dentoalveolar structures Hope this helps!
Thank you so much for your help and explaining everything out for me. I truly appreciate it! If I were to also add dentures to this same claim, would that also need a modifier and/or narrative? Also I didn”t see a CDT to CPT cross code available for D5130 maxillary immediate denture or D5140 Mandibular immediate denture, do I just use the CDT codes for those? Thank you!!!
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