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Guest
#1 Posted : Monday, May 7, 2018 11:33:10 AM(UTC)
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Guest

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In Dec 2016 my daughter had pontics and crowns placed as medically necessary for the treatment related her cleft lip/palate.
The dental office and insurance company are both telling me I need to get medical codes but neither is providing the codes.
I have the following dental codes:

D6245
D6740

If you can help it would be a miracle!
THANKS
courtneydsnow
#2 Posted : Monday, May 7, 2018 11:41:42 AM(UTC)
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courtneydsnow

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Hi Guest!

D6245 - pontic - porcelain/ceramic
D6740 - retainer crown - porcelain/ceramic

The codes listed above do not have a direct crosscode 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 try the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures

Hope this helps!
Guest
#3 Posted : Monday, May 7, 2018 12:45:42 PM(UTC)
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Guest

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Thank you, The insurance company is refusing to accept dental codes. So I will try your code. Do I put CPT in front of the numbers?

courtneydsnow
#4 Posted : Monday, May 7, 2018 2:24:13 PM(UTC)
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courtneydsnow

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Hi Guest!

Great question. There is no need to put "CPT" in front of them, but depending on what type of form the insurance company provided you to submit this request, you will want to provide a description of what services the code is being used to represent.

Hope this helps!
Guest
#5 Posted : Thursday, September 23, 2021 3:20:37 PM(UTC)
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Guest

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WHAT TYPE OF DIAGNOSIS CODES WOULD GO WITH THESE PROCEDURES
courtneydsnow
#6 Posted : Friday, September 24, 2021 8:17:03 AM(UTC)
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courtneydsnow

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Hi Guest!

The ICD-10 diagnosis codes for cleft lip & palate are as follows:

Q35.1 - Cleft hard palate
Q35.3 - Cleft soft palate
Q35.5 - Cleft hard palate with cleft soft palate
Q36.0 - Cleft lip, bilateral
Q36.1 - Cleft lip, median
Q36.9 - Cleft lip, unilateral


Hope this helps!
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