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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
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Rank: Administration
Joined: 11/21/2012(UTC)
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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!
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Rank: Guest
Joined: 9/8/2012(UTC)
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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?
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Rank: Administration
Joined: 11/21/2012(UTC)
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Was thanked: 51 time(s) in 51 post(s)
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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!
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Rank: Guest
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WHAT TYPE OF DIAGNOSIS CODES WOULD GO WITH THESE PROCEDURES
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Rank: Administration
Joined: 11/21/2012(UTC)
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Thanks: 39 times
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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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