Hi guest!

Yes the procedure codes you listed look good. There is not a standard modifier I am aware of to use in these cases.

As for the diagnosis code, it will of course depend on the specific patient and their condition, however here are some common examples:

K00.6 - Disturbances in tooth eruption
K01.1 - Impacted teeth
M26.31 - Crowding of fully erupted teeth

And yes here are the full descriptions of the anesthesia codes:

D9243 - Intravenous moderate (conscious) sedation/analgesia – each 15 minute increment

00170 - Anesthesia for intraoral procedures, including biopsy; not otherwise specified
00172 - Anesthesia for intraoral procedures, including biopsy; repair of cleft palate
00174 - Anesthesia for intraoral procedures, including biopsy; excision of retropharyngeal tumor
00176 - Anesthesia for intraoral procedures, including biopsy; radical surgery
01999 - Unlisted anesthesia procedure(s)

• 99143 - Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time

• 99144 - Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time

• 99145 - Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; each additional 15 minutes intra-service time (List separately in addition to code for primary service)

• 99148 - Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; younger than 5 years of age, first 30 minutes intra-service time


I don't believe you will want to use modifier -25 because that stands for: Modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service)

Evaluation & management (E&M) services are generally considered to be services like office visits/exams.


• 99149 - Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; age 5 years or older, first 30 minutes intra-service time

• 99150 - Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intra-service time (List separately in addition to code for primary service)

Hope this helps, have a great day!

Hi Monica,

The 41899, unspec. Dentoalveolar procedure, with report is still valid. Perhaps the insurance is accepting the CDT code on a CMS 1500 medical claim (some carriers prefer the CDT code vs. 41899).

The new moderate sedation codes are:

Sedation codes include presence of independent trained observer
Moderate (Conscious) Sedation > 5 years, first 15 min. 99152
Moderate Sedation > 5 years, ea. Addit. 15 min. (add on code) 99153


Hope this helps!

Hi Guest!

Yes you certainly can!

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:
http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v5.pdf

Hope this helps!

Hi Guest!

Great question. Yes, for extraction, you can either use the "D" code, or if the insurer doesn't accept "D" codes you can instead use: 41899 - Unlisted procedure, dentoalveolar structures

You are correct on the JP qualifier, for those 4 teeth numbers, it would be displayed as:
JP1 16 17 32
(no space in between the JP and the first tooth number listed)

If you use 41899, you can also use the ZZ qualifier to enter a short description, like this:
ZZextractions JP1 16 17 32

And yes, 00170 stands for: Anesthesia for intraoral procedures, including biopsy; not otherwise specified

As for a modifier, you may consider:
QS - Monitored anesthesia care (MAC) services (can be billed by a qualified nonphysician anesthetist or physician)

Hope this helps!

Hi Guest!

D9222 – deep sedation/general anesthesia – first 15 minutes
can be crosscoded to:
00170 - Anesthesia for intraoral procedures, including biopsy; not otherwise specified


D9612 - therapeutic parenteral drugs, two or more administrations, different medications
can be crosscoded to:
96372 - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
or
96373 - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intra-arterial
or
96374 - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug


D7240 - Removal of impacted tooth - completely bony

As for the CPT code (medical procedure code) for extractions, there is actually not direct crosscode, 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 use one of the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures


If you use 41899, you can also use these qualifiers in the supplemental information area on the line item:
- the JP qualifier to indicate the tooth numbers
- the ZZ qualifier to enter a short description, like this:
ZZextractions JP1 16 17 32


An example of how to use the JP qualifier on the medical claim can be found int he NUCC's claim form manual on page 48, here is a link to it:
https://nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2021_07-v9.pdf


You will also need a diagnosis code or codes for the medical claim as well. A common one for wisdom teeth extraction is:
K01.1 - Impacted teeth


Hope this helps!

Hi Guest!


D7240 - Removal of impacted tooth - completely bony
D7230 - Removal of impacted tooth - partially bony

There are not standard modifiers to use for removal of impacted teeth, although if you performed multiple surgeries on the sane date of service, modifier 51 can be appended to each additional surgery after the first listed (most expensive) on the claim.

Or, for example if the removal was more complicated than the normal, you can consider modifier 22 for increased procedural service.

You may also consider using the ZZ and/or JP qualifiers to provide additional information on the line item.

The JP qualifier to indicates the tooth numbers. So for example, if it is wisdom teeth extractions, it would read:
JP1 16 17 32

Now, some medical insurers will not process "D" codes on the medical claim (some will). For ones that don't you code extractions as CPT 41899 (which stands for Unlisted procedure, dentoalveolar structures), because surprisingly enough, there is still not a specific CPT code for extractions!
So, the ZZ qualifier indicates you will be providing a short description, like this:
ZZextractions JP1 16 17 32

An example of how to use the ZZ and JP qualifiers on the medical claim can be found int he NUCC's claim form manual on page 47 & 48, here is a link to it:
https://nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2021_07-v9.pdf


Hope this helps!

Hi Guest!

Great question. You may not need a modifier at all, if that is the only service being billed on that claim/date of service, then there is not standard modifier i'm aware of to use for that. However - let's say you also billed an Evaluation & Management (E&M) code (aka office visit code) that same day, then you would want to append modifier 25 onto the office visit code to show it was a separately identifiable E&M service on the same date as a procedure.
Or, another example would be if there are other surgical procedures billed on that same claim/date of service, then you would want to append the modifier 51 onto any surgical service on that after the first (most expensive) one.

Hope this helps!

Hi! We had a patient last week that we saw for a consultation for wisdom teeth. She has three wisdom teeth (#1, #16 and #32) AND, she has two extra #32’s. So, three #32’s in total. What code do I use for the XX#32?