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A dental claim submitted for D7880 was denied because an arch (upper or lower) code was not provided. This is the first time we have run into this issue. I am having difficulty trying to find the arch code. Is the insurance being difficult?
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Hi MedCenter TMJ!
While dental insurance is not our forte here (we assist dental practices with medical insurance billing), I do know that there were new codes release fairly recently for occlusal guards replacing D9940:
D9944 occlusal guard – hard appliance, full arch
D9945 occlusal guard – soft appliance, full arch
D9946 occlusal guard – hard appliance, partial arch
But, those of course don't specify upper or lower, just hard/soft and full or partial arch.
On the medical claim, there are codes that can be added to the supplemental information area on the line items of the claim to indicate areas of the oral cavity, called the JO qualifiers:
00 : Entire oral cavity
01 : Maxillary arch
02 : Mandibular arch
10 : Upper right quadrant
20 : Upper left quadrant
30 : Lower left quadrant
40: Lower right quadrant
So for example, to indicate the upper arch, it would be entered as: "JO01" and for the lower arch "JO02"
Hope this helps!
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