Hi Guest!

Yes if the dentures are on the same date of service as other procedures/services, you can use modifier 51. If it is a different date of service, there is no standard modifier to use.

And yes you're correct, for:

D5130 - immediate denture maxillary
D5140 - immediate denture - mandibular

The codes listed above do not have direct crosscodes 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!

HI ACS!

Absolutely, you have come to the right place!

Great questions. Some medical insurers will not accept any "D" codes on the medical claim form, although many do these days. So, your best bet may be to go ahead and use the crosscoded CPT codes to avoid delays in case the insurers is unable to process "D" codes.

So, for the example you gave, here is how I would set it up on the medical claim:

Put all of the extractions on 1 line item with the fee reflecting all of them, using CPT 41899. In the "supplemental information" area of the line item (the red shaded line that is typically left blank), enter this:
ZZextractions JP3 4 7 10 11 24

ZZ means "narrative description to follow", and "JP" means "tooth number(s)"


Now, for the Alveloplasty, go ahead and use 41874 as you mentioned, for the supplemental information on this one, you'll instead of the "JO" qualifiers and use these numbers to indicate the quadrant:
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:
https://nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2020_07-v8.pdf


As for modifiers, if these procedures were done on the same date of service, you will want to append modifier 51 (multiple surgeries/procedures) to the lesser expensive of the two line items.

If you have any questions or would like some assistance in DentalWriter getting this done, please feel free to reach out to us at training@dentalwriter.com and we are happy to help!