Hello everyone!
My name is Mallory and I work as a coder/biller for an oral/maxiollofacial surgeon in Lee's Summit, MO. While the majority of our practice is dental related (wisdom teeth, jaw bone grafting, etc.) my physician also does trauma rounds at the hospital, sees patient's for oral pathology, etc. We have both a dental and medical contract with our local BCBS which accepts the D codes in lieu of the medical CPT codes. Lately, we have been finding some out of state BCBS plans (Blue Card) that are not processing the D codes, in fact they will kick out the claim entirely, at which point I have to turn around and re-submit all the corresponding CPT codes from the patient's surgery. As far as I knew, everything was processed through our local, so I'm having trouble understanding how some of the Blue Card plans don't process the D codes. Does anyone else have any experience with this sort of thing? There always a fine line when it comes to cross coding as well as medical insurances paying for dental services. I'd love any kind of feedback! Thank you!
My name is Mallory and I work as a coder/biller for an oral/maxiollofacial surgeon in Lee's Summit, MO. While the majority of our practice is dental related (wisdom teeth, jaw bone grafting, etc.) my physician also does trauma rounds at the hospital, sees patient's for oral pathology, etc. We have both a dental and medical contract with our local BCBS which accepts the D codes in lieu of the medical CPT codes. Lately, we have been finding some out of state BCBS plans (Blue Card) that are not processing the D codes, in fact they will kick out the claim entirely, at which point I have to turn around and re-submit all the corresponding CPT codes from the patient's surgery. As far as I knew, everything was processed through our local, so I'm having trouble understanding how some of the Blue Card plans don't process the D codes. Does anyone else have any experience with this sort of thing? There always a fine line when it comes to cross coding as well as medical insurances paying for dental services. I'd love any kind of feedback! Thank you!