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evelyn0002
#1 Posted : Sunday, May 2, 2021 8:01:08 PM(UTC)
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evelyn0002

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Joined: 5/2/2021(UTC)
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When you bill for Periodontal scaling - four or more teeth per quadrant (D4341),

1. do we set up the medical code D4341's price for each quadrant? and 4 units under Box24G?
2 Or should the price represent all four quadrants? and the unit will be one (1)?

Thank you
courtneydsnow
#2 Posted : Tuesday, May 4, 2021 8:44:43 AM(UTC)
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courtneydsnow

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Hi evelyn0002!

Great question. If the medical insurer you are filing to accepts & processes "D" codes - then I would recommend what you said in option #1 - set up D4341 as the price per quadrant, and list 4 units on that line item in field 24g. Reason i say that is because "per quadrant" is included in the description of the code.

If the medical insurer you are filing to does not accept/process "D" codes, there is actually not a direct crosscode from dental to medical for D4341, so you end up using the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures
In this scenario, I suggest using 1 unit of this code and the full fee for all quadrants completed.


Fun tip:
You can also use the "JO" qualifier in the supplemental information area on the line item of the claim to indicate areas of the oral cavity! (the supplemental information area is the red shaded line that is typically left blank),

Here are the "JO" qualifiers that indicate the quadrants:
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


Hope this helps!
Guest
#3 Posted : Tuesday, May 4, 2021 1:16:33 PM(UTC)
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Guest

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Thank you for the information. This is very helpful

I was putting the quadrant #s, 01 through 04, in the modifier boxes, and 4 units.

Again, thanks.

Guest
#4 Posted : Tuesday, May 11, 2021 1:02:20 AM(UTC)
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Guest

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Just realized that JO is not modifiers. Got it.
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