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#1 Posted : Wednesday, May 19, 2021 10:20:53 AM(UTC)

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Hello there,
I'm new to medical billing and confused that when we submit medical billing for dental procedures,
1)I don't see any area in the 1500(02-12)form for the tooth #, or quadrants, which means there is no need to mention that which tooth or teeth # and quadrants we are billing for?
2)If multiple dental procedures D4260 for the different quadrants then we just add the multiple units in 14-G(days or Units) and total charges for all?
I really appreciate it if I can get some help with this, thank you so much.
#2 Posted : Thursday, May 20, 2021 11:44:28 AM(UTC)

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Hi Guest!

Great questions. Good news is, there is a place on the CMS1500 medical claim form where you can indicate tooth numbers and areas of the oral cavity when needed! It's just not an obvious thing :)

To do this, you use qualifiers in the supplemental information areas on the line item of the procedure in field 24 of the claim (this is the red shaded portion of each line item that is usually left blank).

The following are the codes for tooth numbers, reported with the JP qualifier:
• 1 –32: Permanent dentition
• 51 –82: Permanent supernumerary dentition
• A –T: Primary dentition
• AS –TS: Primary supernumerary dentition

The following are the codes for areas of the oral cavity, reported with the JO qualifier:
• 00 : Entire oral cavity
• 01 : Maxillary arch
• 02 : Mandibular arch
• 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 & 47:

Now, as for whether to increase the units for a service like D4260 (osseous surgery (including elevation of a full thickness flap and closure) – four or more contiguous teeth or tooth bounded spaces per quadrant) - that will actually depend on whether the medical insurer accepts the "D" code or not! If using the "D" code, then yes increase the units to indicate how many, and you can use the J) qualifier to specify the quadrants on the line item as well.
However, if the insurer won't process "D" codes and requires a CPT code instead, there is actually not a direct crosscode we are aware of, so you end up using an "unlisted procedure" code - the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures

In this case, you would do 1 unit with the entire fee instead. You can use the "ZZ" qualifier to include a short narrative description right on the line item!

Hope this helps!
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