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In Dec 2016 my daughter had pontics and crowns placed as medically necessary for the treatment related her cleft lip/palate. The dental office and insurance company are both telling me I need to get medical codes but neither is providing the codes. I have the following dental codes: D6245 D6740 If you can help it would be a miracle! THANKS
Hi Guest! D6245 – pontic – porcelain/ceramic D6740 – retainer crown – porcelain/ceramic The codes listed above do not have a direct crosscode 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, The insurance company is refusing to accept dental codes. So I will try your code. Do I put CPT in front of the numbers?
Hi Guest! Great question. There is no need to put “CPT” in front of them, but depending on what type of form the insurance company provided you to submit this request, you will want to provide a description of what services the code is being used to represent. Hope this helps!
Hi Guest! The ICD-10 diagnosis codes for cleft lip & palate are as follows: 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 Hope this helps!
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