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Wiki Help - can DDS/DMD bill 99215 and 99244

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KathyHill15

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Help - does anyone out there know if dentists are allowed to bill any of the medical E&M codes? Especially the higher severity codes?
I work for an insurance company and am trying to determine if this is contraindicated. I am seeing cases where a dentist billed 99215 and 99244 and am wondering what guidelines are out there for educating the provider if this shouldn't be occurring. We aren't paying it, but I am wondering if he should even be billing it. I am not familiar with dental codes and I don't know if there are synonymous codes in their code set.
 
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Rachel780 said:
KathyHill15 said:
Help - does anyone out there know if dentists are allowed to bill any of the medical E&M codes? Especially the higher severity codes?[/QUO

Are you billing the patient's medical policy? You should be able to crosswalk the dental exam code to an E&M code.
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I work for an insurance company and am trying to determine if this is contraindicated. I am seeing cases where a dentist billed 99215 and 99244 and am wondering what guidelines are out there for educating the provider if this shouldn't be occurring. We aren't paying it, but I am wondering if he should even be billing it. I am not familiar with dental codes and I don't know if there are synonymous codes in their code set.
Click to expand...
 
I work as a dental biller and I am not sure why a dentist would try to get payment for an exam from a medical policy. If it were my provider, I would bill the exams to the dental policy and bill the procedure to the medical policy if appropriate.


KathyHill15 said:
Rachel780 said:
I work for an insurance company and am trying to determine if this is contraindicated. I am seeing cases where a dentist billed 99215 and 99244 and am wondering what guidelines are out there for educating the provider if this shouldn't be occurring. We aren't paying it, but I am wondering if he should even be billing it. I am not familiar with dental codes and I don't know if there are synonymous codes in their code set.
Click to expand...
Click to expand...
 
Rachel780 said:
I work as a dental biller and I am not sure why a dentist would try to get payment for an exam from a medical policy. If it were my provider, I would bill the exams to the dental policy and bill the procedure to the medical policy if appropriate.



They are billing them in addition to E0486 which is being billed on the patient's medical plan
Click to expand...
 
KathyHill15 said:
Rachel780 said:
I work as a dental biller and I am not sure why a dentist would try to get payment for an exam from a medical policy. If it were my provider, I would bill the exams to the dental policy and bill the procedure to the medical policy if appropriate.




They are billing them in addition to E0486 which is being billed on the patient's medical plan
Click to expand...

With that procedure, I would agree with the submitting of those E&M codes.
Click to expand...
 
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