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Dental coding ASC

  1. #1
    Question Dental coding ASC
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    Has anyone had any luck with Medical Insurnace paying for dental codes. If so what codes do you use thanks.

  2. #2
    41899 is the only choice you have if your contracts don't allow D codes. Be careful, Always check the insurance carrier for coverage in ASC under the patient's plan and verify if an auth is required. Most contracts won't cover routine extractions unless trauma,neoplasm, etc. Verify, Verify, Verify.

  3. Unhappy
    Be careful re: prior authorizations. The dental surgeons get prior auths from the payers and want to schedule the surgeries at the surgery center.... but they mean nothing. We've had numerous cases where the payer will provide a prior auth for facility fees and anesthesia because of 'medical neccesity'....but of course all prior auths come with the caveat that they are not a guarantee of payment. The payer ends up denying the claim - despite the prior auth - because the terms and conditions of the individual's medical policy state that no facility fees for dental work will be covered - usually unless you can provide proof of injury or severe SEVERE disability. So the prior auths mean nothing...the patient is left with the balance and oftentimes dismayed because 'the surgeon's office said it would all be covered.'

    Also be careful with state laws. Our state has a law on the books that anesthesia and out patient/facility charges must be covered for dental procedures under medical insurance if the patient is age 4 or under. But many payers have gotten around this by having stipulations written in their contracts/policies that they do not follow state laws re: dental procedures being covered under medical insurance - so no coverage even if the pt is 4 or under. Unfortunately when you call provider service at any insurance company, it may take several conversations through several people before you can connect with someone who knows what you're talking about - and knows where to look in the benefits screens for the tiny details about dental procedures. It's hours of frustration.

  4. #4
    Thanks for the information, I spent 45 minutes on the phone trying to get benefits for a patient, the medical insurance would send me to the dental insurnace who would in turn send me back to the medical and I still did not get an answer.

  5. #5
    unlisted codes will not get the reimbursement you deserve, I very well know. This is hard to get approval for and it has to be in the patients benefits. When calling you must be specific that this is dental extractions. I work for an ASC and we never rely on the dental surgeon's office for this information. The unlisted code, 41899, is all that can be used IF, and I repeat IF this is done in an ASC. Medicare as all knows this is a no no. These procedures if done in an ASC should be self pay. Routine dental extractions, full mouth...self pay, regardless, any insurance.
    However, there are times when a patient has been in a car accident, and IF covered under their benefits can be done. You must make the rep dig for this. Excising a tooth or teeth to remove a plate placed due to a previous car accident, the surgeon must remove the tooth or teeth to remove. You must use good judgement on these cases. I also suggest to keep from the hassle and possible denial don't do. NEVER RELY ON THE OFFICE FOR THE INFORMATION...CALL YOURSELF.
    If ever in doubt talk to your office manager or administrator for direction on these cases BEFORE they are done. YOUR BEST RESOURCE.
    Last edited by dchagy; 09-25-2010 at 07:54 PM.

  6. #6
    Forgot to mention, if a patient states they have for example, Delta Dental, this does not matter you will NOT file dental. This will be self pay and if they want to try to get reimbursement the patient can file this to his/or her insurance. Any dental extractions done in an ASC is always brought to my administrator's attention should the office want to schedule and request insurance filed. All our services must meet all state and local guidelines for any procedure and this is what the patient is told. When a self pay patient is done this CPT code is used, 41899.
    Should and if we obtain the required and written authorization, and believe me I have been on line with the reps longer than 45 minutes, documentation is essential for any procedure and specific questioning to get specific answers. I have also placed calls to our provider reps for informtion under our contracts. I have had no appeal situations yet (knock on wood) for our only two cases done and these were done due to trauma or in a different quad. So beware.!! No stone should go uncovered. Better yet, don't do any under medical insurance.

  7. Default Help
    Does anyone know the appropriate anesthesia procedure code for the unlisted 41899?

  8. Default 41899 Anesthesia Codes
    At our ASC for the anesthesia code dental extractions is 00170 with DX 520.6 Disturbance in tooth eruption.

    If an osteotomy is performed (21025 or 21026) with the tooth extraction then you would use anesthesia code 00190 with DX 526.4 Inflammatory Conditons of the Jaw

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