Need help with medical ins. claim

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Hersheydmd
Posts: 700
Joined: Sun May 03, 2009 9:12 pm

Need help with medical ins. claim

Post by Hersheydmd » Thu Aug 21, 2014 4:50 pm

I am trying to obtain a pre-treatment estimate from Aetna Medical for implant restorations to replace congenitally missing #6, 7, 10, 11.
1) Is the correct ICD-9 code for a congenitally missing tooth 520.0 or is it 525.50? Or do I put down both?
2) Is there a CPT code for the implant, or the abutment, or the crown, or should I just use the dental procedure codes?
3) What would be an appropriate modifier? Do I need a modifier?
Robert M Hersh DMD, FAGD
Univ. of Penn 1982
Brooklyn, NY 11234
https://www.facebook.com/pages/Robert-M ... 1471599429

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jsalmon
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Re: Need help with medical ins. claim

Post by jsalmon » Thu Aug 21, 2014 11:48 pm

I'm going to be of no use at all for these types of questions. When I was helping program these code systems all I could think of to myself was "I'm so glad I'm not a doctor". This is how it all looks to me:

Hungry Man ICD 9
502.00 - PB & J Sandwich
502.10 - PB & J Sandwich, Jelly Spread With Knife
502.20 - PB & J Sandwich, Jelly Spread Without Knife
502.30 - PB & J Sandwich, With Unknown Jelly Found (IN SPUTUM) By Microscopy
502.40 - PB & J Sandwich, (Diagnosis)

:shock:
Um... I just wanted to indicate that I ate a PBJ... Now I don't even remember how I prepared it. Is 502.00 too generic? I think I used a spoon, so does that mean I need to use 502.20? And what the heck is 502.40? Oh forget it, I'm just going to use 340.60 - Peanut Butter Jelly Time

Oh look over here... ICD 10, SNOMEDS, RXNORM, UCUM, etc, etc,... Goody
The best thing about a boolean is even if you are wrong, you are only off by a bit.

Jason Salmon
Open Dental Software
http://www.opendental.com

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Hersheydmd
Posts: 700
Joined: Sun May 03, 2009 9:12 pm

Re: Need help with medical ins. claim

Post by Hersheydmd » Fri Aug 22, 2014 6:35 am

It's no joke. No wonder this country's medical system is so screwed up.
Robert M Hersh DMD, FAGD
Univ. of Penn 1982
Brooklyn, NY 11234
https://www.facebook.com/pages/Robert-M ... 1471599429

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