Hi we're a pediatric office, and we do space maintainer's constantly. One of these appliances are called a Bilateral Space Maintainer, and insurance companies always deny this code (D1515). The insurance carriers say we are not submitting the correct teeth numbers with that appliance.
This appliance requires us to use TWO teeth numbers, as it is replacing two or more lost or extracted teeth. Currently, it seems the only way to do this would be to add the teeth they're replacing in the "remarks for unusual services" on the claim form. However, insurance companies have a convenient way of acting like this box does not exist.
Has anyone else run into problems submitting Bi-Lateral space maintainers to insurance companies? Is there a work-around in open dental? Does anyone have a temporary fix for this problem?
Creating a Claim with Bilateral Space Maintainers
-
BHavenKidsDent
- Posts: 7
- Joined: Mon Mar 18, 2013 10:38 am
Re: Creating a Claim with Bilateral Space Maintainers
Change the treatment area for that code from "Tooth" to "ToothRange" under (lists/procedure codes). Then you can select two teeth and code out for the D1515.
-
BHavenKidsDent
- Posts: 7
- Joined: Mon Mar 18, 2013 10:38 am
Re: Creating a Claim with Bilateral Space Maintainers
Hello and thanks for that insight. I did as you said, and changed it to a tooth range, however this is only for permanent teeth. We have to use baby teeth when submitting the space maintainer. I tried putting notes into the remarks for unusual services box on the claim form. Unfortunately, most insurance carriers ONLY look at the tooth box, and they have denied claims when we substitute the adult tooth instead of the baby tooth. Surely there is a work-around that will allow me to put multiple BABY teeth in the "tooth box" on the claim form?
Re: Creating a Claim with Bilateral Space Maintainers
I poked around a bit and did not find a workaround. I believe that the permanent tooth limitation is coded into the program and you'd have to speak to OpenDental about changing that limitation for that procedure code.
Re: Creating a Claim with Bilateral Space Maintainers
The tooth range treatment area only works for permanent teeth. See Feature Request #3333 "Add the ability to select primary teeth for procedure codes set up to use the "tooth range" treatment area."