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When you bill for Periodontal scaling – four or more teeth per quadrant (D4341), 1. do we set up the medical code D4341”s price for each quadrant? and 4 units under Box24G? 2 Or should the price represent all four quadrants? and the unit will be one (1)? Thank you
Hi evelyn0002! Great question. If the medical insurer you are filing to accepts & processes “D” codes – then I would recommend what you said in option #1 – set up D4341 as the price per quadrant, and list 4 units on that line item in field 24g. Reason i say that is because “per quadrant” is included in the description of the code. If the medical insurer you are filing to does not accept/process “D” codes, there is actually not a direct crosscode from dental to medical for D4341, so you end up using the CPT code below and include a narrative report describing the procedure: 41899 – Unlisted procedure, dentoalveolar structures In this scenario, I suggest using 1 unit of this code and the full fee for all quadrants completed. Fun tip: You can also use the “JO” qualifier in the supplemental information area on the line item of the claim to indicate areas of the oral cavity! (the supplemental information area is the red shaded line that is typically left blank), Here are the “JO” qualifiers that indicate the quadrants: 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: Hope this helps!
Thank you for the information. This is very helpful I was putting the quadrant #s, 01 through 04, in the modifier boxes, and 4 units. Again, thanks.
In general, the price for a dental procedure, including Periodontal , can be set up either per quadrant or as a total for all quadrants, depending on the billing practices of the dental practice or insurance company. The code for Periodontal scaling – four or more teeth per quadrant (D4341) should be used once per quadrant treated, and the number of units should reflect the number of quadrants treated. So, if all four quadrants are treated, then the code should be billed four times with four units in Box24G. The price for each code can be set up per quadrant or for all four quadrants, depending on the billing practices. It”s always best to consult with your dental billing and coding resources or seek advice from a professional in the field to ensure accurate and compliant billing practices.
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