rebecca@pmc-consulting.net
Contributor
New coder.. does anyone have any great resources to help?
Thank you!!
Thank you!!
Thank you so much!! We are billing for oral surgery, perio surgery and CT Scans.I work in dentistry as a fraud waste and abuse investigator and code/review records regularly. We do not see too many medical claim situations come through. I am glad to help in any way I can. What type of medical billing are you doing? Oral surgery?
I am having a difficult time with United Healthcare, I continue to rec denials from them.I work in dentistry as a fraud waste and abuse investigator and code/review records regularly. We do not see too many medical claim situations come through. I am glad to help in any way I can. What type of medical billing are you doing? Oral surgery?
Thank you--- I received this denial and not sure how to proceed with resubmitting? Thank you for the help!!!I work in dentistry as a fraud waste and abuse investigator and code/review records regularly. We do not see too many medical claim situations come through. I am glad to help in any way I can. What type of medical billing are you doing? Oral surgery?
Thank you ... here is the claim sent--I have worked on the payer side of the industry for 20+ years and the instances where dental services such as implants 21248 and the oral splint casting are covered under the patient's medical health plan benefits. In addition to the EOB for this claim, it would be helpful to see a copy of the claim form submitted and the procedure notes to figure out if this claim is one of the rare instances where oral surgery services might be covered under the patient's medical plan benefits.
The one thing that pops out at me is that 21248 has an MUE maximum of 2 units per DOS, so it makes sense that the 3rd unit of 21248 was denied as over the maximum units for the DOS.
The 21248 procedures seem to be "routine" dental services based on the diagnoses billed, which wouldn't be covered under most patient's medical plan benefits. Did you receive some type of information that the patient does have coverage under the medical plan benefits for these services in particular?Thank you ... here is the claim sent--
Ok, so should I submit a new claim using 21249? with a claim correction form? THank you so much for the help!!The 21248 procedures seem to be "routine" dental services based on the diagnoses billed, which wouldn't be covered under most patient's medical plan benefits. Did you receive some type of information that the patient does have coverage under the medical plan benefits for these services in particular?
As for 21085 being denied due to a diagnosis mismatch, the primary DX J34.9- unspecified disorder of the nose and nasal sinuses doesn't seem appropriate for this service. What is the medical reason the patient needed an oral surgical splint that necessitated taking the impression and custom preparation that led you to bill 21085?