Need medical code corresponding to dental code

[niermanpm]

Thanks for the reply, but aren”t those codes only for supplies (not the procedure)? The main cost is not for supplies but for the time and expertise of performing the D0470 procedure to obtain a good cast of the patient”s bite to study in preparation for surgery. Is there a medical code for this procedure? Thanks!

[niermanpm]

Hi guest! D0470 – diagnostic casts can be crosscoded to: 99070 – special supplies & materials A4580 – cast supplies (e.g. plaster) Hope this helps, have a great day!

[niermanpm]

Hi, Medical insurance will not recognize or convert D0470 for diagnostic cast/study model prior to orthognathic surgery, even though their medical policy states that diagnostic cast/study models are medically necessary for this purpose, and they requested and received the casts/models to approve payment for the surgery. The cast was only for a study model for the surgery to correct mandibular hyperplasia. No splint was fabricated to put into the mouth. Can you help with a medical code for D0470? Thanks!

[niermanpm]

Hi guest! Yes, the codes are for the supplies. D0470 stands for Study models/Diagnostic casts. As for the surgery itself, what type of surgery is being performed so I can offer you some coding options? For example, here is a link to Aetna”s medical policy titled Orthognathic Surgery: In this policy, (near the middle/bottom), you will find a set of surgical codes that applies to the policy.

[niermanpm]

Thanks again, but I must not be making my question clear. I agree that D0470 is for Study models/Diagnostic casts, but D0470 is for the procedure of making the cast, not for the supplies used (or only a very tiny amount for supplies). Nearly all of the cost of the D0470 procedure is the time involved for the health professional to ensure that a good cast is obtained. Thus, a code for supplies will not capture the cost of the health professional’s time in making the cast. It may be (as some tell me) that there is no medical code corresponding to D0470. Yet, both the insurer I am dealing with and the Aetna link you kindly provided require that a diagnostic cast/study model (i.e., a cast obtained by performing the D0470 procedure) be submitted to the insurer’s medical reviewers to make a determination of medical necessity for the surgery. So, we are in the position of the insurer requiring the submission of results from a diagnostic procedure for which they provide no way to bill, since they refuse to process D0470. In one online forum, someone suggested using 21085 (with modifier 52) for Impression and custom preparation of an oral surgical splint to substitute for D0470, but no surgical split is being prepared, though an impression is being taken. Also, the cost for 21085 is very high compared to what dental insurance normally pays for D0470 when used for dental purposes (which is not the case here). Here”s the link: https://www.aapc.com/memberarea/forums/56706-help-billing-diagnostic-cast-maxillofacial-surgery.html If you have any additional information, that would be most appreciated. But if this is mission impossible, thanks for your time.

[Jeremy Hobbs]

Medical code for D0470

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