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Hi,
I recently had a medical procedure in the dental office. So I had to convert all those dental codes to CPT codes for medical claim purpose. However, I got some items denied by the medical insurance company.
I am planning to make an appeal.
D9612 -- I converted it to 00170 in the original claim. It turned out that the insurance company said the billing amount exceeds the allowable amount (only half is covered). So I try to look it up further on internet, I learned that the D9612 is actually a HCPCS code. Does other medical insurance company (Mine is Premera Blue Cross) accept HCPCS code other than CPT code for medical claim? Will I get into a total loss situation that if I convert the code back to HCPCS again and ask for claim re-process and then turn out they don't accept the HCPCS code?
D4265 -- I converted it to 99070 in the original claim according to the advice I got here. However, it turned out that 99070 is no longer a billable CPT code. Any other billable CPT or HCPCS code for this one?
D4263 -- I converted it to 21215 three times in the claim, as the dental code showed three times in the statement for three different tooth positions. And then, it turned out exceed the daily frequency, one got denied. So may I know if there is another CPT code for this as well?
Thank you so much in advance for answering.
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest!
Great questions.
D9612 - therapeutic parenteral drugs, two or more administrations, different medications
So, not all medical insurers currently will process "D" codes.
You are absolutely correct, "D" codes are HCPCS codes, and medical insurers do process other HCPCS codes, for example E0486 for custom made oral appliances to treat obstructive sleep apnea.
So, we do see many medical insurers these days that will process "D" codes when there is not a direct CPT crosscode available, but not all unfortunately. It is certainly worth asking your insurer!
As for 99070 - yes we do see insurers deciding to list that code as non-reimbursable for their companies, although it is still a valid CPT code. The "D" code may be your best bet for this case if they won't accept an unspecified code!
As for 21215, that is typically billed in 1 unit on the claim, and the entire fee for the grafting applied to it. Dental insurance coding for bone grafting is a bit different - with medical coding, it is simply split into a code for maxillary (upper jaw) bone grafts (21210) and mandibular bone grafts (21215).
Hope this helps!
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