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Guest
#1 Posted : Monday, September 12, 2016 4:06:08 PM(UTC)
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Guest

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A few dental insurance companies are requiring that the removal of wisdom teeth be submitted to a patient's medical insurance prior to submitting to their dental insurance.

I do know that you use D7230 and D7240 as the CPT code, but I do not know if it needs a modifier and I do not know the appropriate diagnosis code to use or a list of diagnosis codes to choose from. Would you be able to help me?

I also want to verify that the Code D9243 IV Sedation 15 min, should be submitted on a medical claim form as 99145 if the patient is older than 5 years and 99144 if patient is under 5 years. Do I also use the modifier 25??
courtneydsnow
#2 Posted : Tuesday, September 13, 2016 7:46:36 AM(UTC)
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courtneydsnow

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Hi guest!

Yes the procedure codes you listed look good. There is not a standard modifier I am aware of to use in these cases.

As for the diagnosis code, it will of course depend on the specific patient and their condition, however here are some common examples:

K00.6 - Disturbances in tooth eruption
K01.1 - Impacted teeth
M26.31 - Crowding of fully erupted teeth

And yes here are the full descriptions of the anesthesia codes:

D9243 - Intravenous moderate (conscious) sedation/analgesia – each 15 minute increment

00170 - Anesthesia for intraoral procedures, including biopsy; not otherwise specified
00172 - Anesthesia for intraoral procedures, including biopsy; repair of cleft palate
00174 - Anesthesia for intraoral procedures, including biopsy; excision of retropharyngeal tumor
00176 - Anesthesia for intraoral procedures, including biopsy; radical surgery
01999 - Unlisted anesthesia procedure(s)

• 99143 - Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time

• 99144 - Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time

• 99145 - Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; each additional 15 minutes intra-service time (List separately in addition to code for primary service)

• 99148 - Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; younger than 5 years of age, first 30 minutes intra-service time


I don't believe you will want to use modifier -25 because that stands for: Modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service)

Evaluation & management (E&M) services are generally considered to be services like office visits/exams.


• 99149 - Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; age 5 years or older, first 30 minutes intra-service time

• 99150 - Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intra-service time (List separately in addition to code for primary service)

Hope this helps, have a great day!
Monica
#3 Posted : Tuesday, June 13, 2017 6:47:56 AM(UTC)
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I am in the same boat at the previous person that posted about billing to medical. For years we have used 99144 for the sedation and 41899 for the extractions. I have had two medical claims come back this week saying that these codes have changed and will need new codes in order to process. We don't run into this very often and I don't want to buy the CPT code book. I believe the updated code for 99144 is 99156 but I can't seem to find a new code for the 41899. Any suggestions?
mbrzezinski
#4 Posted : Tuesday, June 13, 2017 11:03:42 AM(UTC)
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mbrzezinski

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Hi Monica,

The 41899, unspec. Dentoalveolar procedure, with report is still valid. Perhaps the insurance is accepting the CDT code on a CMS 1500 medical claim (some carriers prefer the CDT code vs. 41899).

The new moderate sedation codes are:

Sedation codes include presence of independent trained observer
Moderate (Conscious) Sedation > 5 years, first 15 min. 99152
Moderate Sedation > 5 years, ea. Addit. 15 min. (add on code) 99153


Hope this helps!
Guest
#5 Posted : Wednesday, September 6, 2017 7:30:58 PM(UTC)
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Do you need to specify which tooth when coding?
courtneydsnow
#6 Posted : Thursday, September 7, 2017 7:25:46 AM(UTC)
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Hi Guest!

Yes you certainly can!

The following are the codes for tooth numbers, reported with the JP qualifier:
• 1 –32: Permanent dentition
• 51 –82: Permanent supernumerary dentition
• A –T: Primary dentition
• AS –TS: Primary supernumerary dentition

The following are the codes for areas of the oral cavity, reported with the JO qualifier:
• 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

Examples of how this would look on the medical claim can be found in the NUCC's CMS 1500 claim form manual here, starting on page 46 & 47:
http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v5.pdf

Hope this helps!
Guest
#7 Posted : Friday, February 25, 2022 12:52:05 PM(UTC)
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When sending wisdom tooth extractions on a medical claim, do I understand correctly that 4 fully impacted wisdom teeth would be billed with D7240 4 units would be used with a modifier jp 1 16 17 32 and with the deep sedation administered by the Oral Surgeron would I code 00170 4 units with a modifier or without a modifier?
courtneydsnow
#8 Posted : Monday, February 28, 2022 3:52:49 PM(UTC)
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Hi Guest!

Great question. Yes, for extraction, you can either use the "D" code, or if the insurer doesn't accept "D" codes you can instead use: 41899 - Unlisted procedure, dentoalveolar structures

You are correct on the JP qualifier, for those 4 teeth numbers, it would be displayed as:
JP1 16 17 32
(no space in between the JP and the first tooth number listed)

If you use 41899, you can also use the ZZ qualifier to enter a short description, like this:
ZZextractions JP1 16 17 32

And yes, 00170 stands for: Anesthesia for intraoral procedures, including biopsy; not otherwise specified

As for a modifier, you may consider:
QS - Monitored anesthesia care (MAC) services (can be billed by a qualified nonphysician anesthetist or physician)

Hope this helps!
Guest
#9 Posted : Tuesday, May 24, 2022 5:02:03 PM(UTC)
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Hi There,
I'm super excited to see this site. We have been trying to get a dental claim paid by pts primary (aetna) which has been denied due to they want us to submit to medical. Unfortunately dental and medical codes are completely different. Here's where I need your help, What code would I use if billing a dental claim to a medical claim gpt procedure was D7240 (impacted tooth) for all 4 wisdom teeth 1,16,7,and 32. along with Deep sedation for D9222 first 15 minutes and D9223 and D9612 which is therapeutic parenteral drugs, two or more administrations, different medications for each additional under medical.
courtneydsnow
#10 Posted : Thursday, May 26, 2022 10:41:50 AM(UTC)
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courtneydsnow

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Hi Guest!

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


D9612 - therapeutic parenteral drugs, two or more administrations, different medications
can be crosscoded to:
96372 - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
or
96373 - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intra-arterial
or
96374 - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug


D7240 - Removal of impacted tooth - completely bony

As for the CPT code (medical procedure code) for extractions, there is actually not direct crosscode, 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


If you use 41899, you can also use these qualifiers in the supplemental information area on the line item:
- the JP qualifier to indicate the tooth numbers
- the ZZ qualifier to enter a short description, like this:
ZZextractions JP1 16 17 32


An example of how to use the JP qualifier on the medical claim can be found int he NUCC's claim form manual on page 48, here is a link to it:
https://nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2021_07-v9.pdf


You will also need a diagnosis code or codes for the medical claim as well. A common one for wisdom teeth extraction is:
K01.1 - Impacted teeth


Hope this helps!
Guest
#11 Posted : Wednesday, June 29, 2022 10:46:46 AM(UTC)
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What modifier do you use for D7230 or D7240?
courtneydsnow
#12 Posted : Wednesday, June 29, 2022 4:57:27 PM(UTC)
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courtneydsnow

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Hi Guest!


D7240 - Removal of impacted tooth - completely bony
D7230 - Removal of impacted tooth - partially bony

There are not standard modifiers to use for removal of impacted teeth, although if you performed multiple surgeries on the sane date of service, modifier 51 can be appended to each additional surgery after the first listed (most expensive) on the claim.

Or, for example if the removal was more complicated than the normal, you can consider modifier 22 for increased procedural service.

You may also consider using the ZZ and/or JP qualifiers to provide additional information on the line item.

The JP qualifier to indicates the tooth numbers. So for example, if it is wisdom teeth extractions, it would read:
JP1 16 17 32

Now, some medical insurers will not process "D" codes on the medical claim (some will). For ones that don't you code extractions as CPT 41899 (which stands for Unlisted procedure, dentoalveolar structures), because surprisingly enough, there is still not a specific CPT code for extractions!
So, the ZZ qualifier indicates you will be providing a short description, like this:
ZZextractions JP1 16 17 32

An example of how to use the ZZ and JP qualifiers on the medical claim can be found int he NUCC's claim form manual on page 47 & 48, here is a link to it:
https://nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2021_07-v9.pdf


Hope this helps!
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