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Guest
#1 Posted : Friday, June 25, 2021 5:13:33 PM(UTC)
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Guest

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Hello,

My 9 year old had oral surgery to extract an impacted "extra" tooth in the center of the roof of his mouth. Insurance denied the claim for the anesthesia saying the procedure (D7240) was not an eligible surgical procedure. How on earth is that not eligible? Was my 9 year old son supposed to lay there away for 30 minutes while the surgeon cut open the roof of his mouth and dug around for a rogue tooth? I need help fighting this claim but I don't understand the jargon.

Here are the codes on the explanation of benefits:

D7240, Extract impacted tooth comp bony
D9222, Deep sedation/gen anes 1st 15
D9223,02, Deep sedation/gen anes addl 15

Any guidance, info or advice is much appreciated.

Guest
#2 Posted : Tuesday, June 29, 2021 2:38:56 PM(UTC)
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Guest

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Usually a "not eligible" denial means that you just don't have this benefit under your specific plan or did not meet the criteria for the plan to pay for the service. I would call the insurance company first to inquire about the claim. and then I would talk to the dental office to make sure they submitted all the information that is needed to have the insurance process it correctly. Did the office warn you taht it was something that might not be covered by the insurance plan? Did the dental office send you a bill for the charges or was this just on the explanation of benefits? Sometimes the dental office is just as surprised as you are to receive the denial and is trying to get it paid by the insurance company.
courtneydsnow
#3 Posted : Friday, July 2, 2021 9:23:02 AM(UTC)
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courtneydsnow

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Hi Guest!

As for the coding:


D9222
– deep sedation/general anesthesia – first 15 minutes
and
D9223 – deep sedation/general anesthesia – each additional 15 minutes
can be crosscoded to:
00170 - Anesthesia for intraoral procedures, including biopsy; not otherwise specified


D7240 - Removal of impacted tooth - completely bony


As for the CPT code for extractions, there is actually not direct crosscodes we are aware of, so you can either bill the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), or you can use one of the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures
42299 - Unlisted procedure, palate, uvula


Hope this helps!
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