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Any suggestions on billing an OralDNA salivary diagnostic test to medical insurance?
We billed the patient's dental insurance and they did not cover the test. They covered part of the exam.
The patient was referred to our office from her primary care physician for the test due to an elevated CRP level, elevated Myeloperoxidase level, some thickness seen on her carotid-IMT, as well as several arterial plaques. There were not any ICD codes listed on the referral.
One of our dentists did a perio exam (ADA D0180) and diagnosed the patient stage 2 periodontitis, Grade A.
Diagnoses codes we were looking at are K05.32 and Z13.84.
The ADA exam code we use is D0180 so we are looking to use CPT 99243.
The ADA for MyPerioPath test is D0417, we are looking to use is CPT 87801.
Also, do you recommend we list an outside lab was used and list a lab charge on the medical claim form?
Any help is greatly appreciated.
Thank you.
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Hi Eastland Dental Center! Great questions! 87801 stands for: Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique Here are links to a few medical policies that list coverage criteria and coding for salivary testing: Aetna: http://www.aetna.com/cpb/medical/data/600_699/0608.htmlWellmark BCBS: https://www.wellmark.com/Provider/MedpoliciesAndAuthorizations/MedicalPolicies/policies/saliva_test.aspx
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