Wiki Help with OMFS Coding/Billing Please? - I have a friend asking me some questions

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nosswald

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I have a friend asking me some questions on Oral Maxillofacial billing and coding and I've told her quite honestly it is beyond my comfort zone to answer her with any amount of authority on the subject. So I'm asking anyone out there who has experience with this for some help please!!!

Her questions to me are as follows:

1) Verify the correct codes for billing for Anesthesia/Sedation for majority of Oral Maxillofacial Procedures are:
a. 00170 & 00172
b. 00174
c. 00176
d. D9220 &D9221
e. D9241 & D9242

2) Does the Surgeon have the ability to bill for all of the above codes? Do the above codes cover a majority of the procedures that OMF Surgeons perform?

3) CMS guidelines state that anesthesia/sedation during an OMFS procedure is inherently included correct? Also, some private Health Plans allow for the sedation/anesthesia to be billed separately, about what percentage of plans allow for this?

Really really appreciate any help anyone can offer even if it's only to answer one of the questions!!!
 
OMS Coding

Hi,
I have about 10 years in OMS, although I've been out of it for about 2 years now. (I'm going to school for CPC certification). Yes, technically they can bill any of these codes. But in my experience:
Our docs always billed D9920 & D9221 for office sedation
I've never billed the D9241 & D9242 for office sedation
The -47 modifier can be used as well, but it's attached to the CPT code and billed like this example: 41806 for procedure and 41806-47 for anesthesia.
The 00170, 00172,00174,00176 and 00190 can be used as well, but they are medical codes vs. dental codes. If a person is having something as serious as what these codes are used for, then they are usually in a hospital or surgical center. In that case, the anesthesiologist or his group bills for the anesthesia. Just as the facility would bill for facility charges.
With the exception of Medicare, anesthesia by a surgeon should be billed separately. Insurance companies sometimes strictly follow Medicare guidelines, so each company has a different way they want you to bill it. Check with each insurance company. Most dental providers still want it billed using either of the D-codes above.
Your friend should get established on the AAOMS.org website. You have to have a docs pin # or part of his/her social security number. They have all kinds of coding papers, a newsletter that also provides coding info, and it helped me a great deal.
If you or your friend have anything else I could help you with, please email me at tfog@triad.rr.com because I don't check this site often.
Beth
 
Good Morning!

I have 8 years of experience in OMS and am still currently with the practice. Below is the experience I have had with billing anesthesia/sedation codes.

As for the anesthesia/sedation codes, here in the office we use for medical 99144 and 99145.

Code 00170, 00172, 00174 & 00176 we don't use often, only if a specific carrier requires the use of it.

General Anesthesia D9220 & D9221 are used only if it is general/deep anesthesia for dental procedures only.

For IV Moderate Conscious Sedation we use D9241 & D9242 for dental procedures performed in the office.

Yes, oral surgeons do have the ability to bill all of these codes and they can be billed with the procedures that an oral surgeon performs. You will want to make sure that you verify the patient's benefits, all plans are different.

CMS guidelines to state that it is included with some procedures, your friend will want to become familiar with their guidelines. I know here in Michigan, if we perform a medical procedure in office and the patient wants to be sedated our doctors understand that it is included and will be written off, that being said they only allow it is it is absolutely necessary with the procedure.

Beth is correct your friend should also become very familiar with the AAOMS website, they are a wealth of information. There are also billing & coding workshops that they put on through out the year which I would strongly suggest they attend if they can.

I do have additional information on this subject from the coding/billing workshop with AAOMS that I could give to them if they would like just have them contact me and I will help however I can.

Amy
 
Thank you both SOOO incredibly much. We've been rather desperate to find some resources in this area since it's very foreign to both of us. I've passed along your responses and contact info to the one in charge of the project, her name is Jennifer. She may contact you directly if she needs more help. I'm hoping you all are more helpful than I've been.

Thank you again!
Nicole
 
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