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Hi there, a patient was born with a cleft palate and is interesting in improving her smile.. we”d look to do ortho and ant. bridge post ortho to achieve desired results the codes we will use will be: D8090 D6740 D6245 D2740 How do you suggest we cross code to submit a medical pre-authorization? Thank you
Hi Guest! First thing you will need for a pre-auth request is diagnosis code(s), here are some options for you below: Q35.1 – Cleft hard palate Q35.3 – Cleft soft palate Q35.5 – Cleft hard palate with cleft soft palate Q36.0 – Cleft lip, bilateral Q36.1 – Cleft lip, median Q36.9 – Cleft lip, unilateral As for the procedure codes: D8090 – Comprehensive orthodontic treatment of the adult dentition D6740 – retainer crown – porcelain/ceramic D6245 – pontic – porcelain/ceramic D2740 – crown – porcelain/ceramic substrate There are not a direct crosscodes we are aware of for these procedures, so you can either use the “D” code on the pre-authorization request/medical claim (many insurers these days will process “D” codes when they are medically necessary services), or you can use the CPT code below and include a narrative report describing the procedure: 41899 – Unlisted procedure, dentoalveolar structures Hope this helps!
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