Fast Facts: Coding Episode 4
[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Coding Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Teresa Duncan, MS.
[Teresa Duncan, MS]
Hello, and welcome to another edition of your Coding Fast Facts. Today we're going to talk about four different codes, but they are pretty much the same code just for different scenarios. You have D9932, D9933, D9934 and D9935, and these are found in the 9000 series. Here's the definition for these particular procedure codes. It is cleaning and inspection of the removables. So you have four different ones because of course, you have removable complete denture upper, complete denture lower, and then you have removable partial denture upper and partial denture lower. So that's why you have four different codes. But really they're very much the same code. The common descriptor for all of these is that it does not include any adjustments. So this is the cleaning and the inspection of removables.
What we're going to talk about here is what do you need to look out for when submitting and dealing with insurance and what are the exclusions that we have to deal with? Well, when it comes to submitting these to the insurance carrier, there's really not much extra that's going to go into it. Just submit the code. They typically do not need any kind of documentation. Usually there is a history on the carriers site that they have had either the partial or the denture made. Well, if that's not the case and the patient is say new to your office or new to this carrier and there is no history, well, in that situation, your insurance coordinator is going to rely on your clinical notes to reflect that it is an upper partial, a lower partial, and then that way they can just screenshot the clinical notes and will be able to send that in. It should be pretty explanatory.
In certain situations, we'll need to send in radiographs and that's fine as long as they are current, usually within two years. If you remember from the other fast facts that we have, we typically want our radiographs to be within two years. And some insurance companies are requesting that radiographs be at least one year old or within one year. Really what that means is that you have current images to look at.
Some plans are very restrictive on how these four procedure codes are processed. Some consider them to be part of an evaluation or part of the preventive procedure. What I mean by that is say you were having them come in for the periodic evaluation and they took out the partial and you cleaned it. There are some very restrictive plans that consider that to be part of the actual evaluation or part of the actual prophy. In that situation, you're going to have to look to see if you are participating with a plan that's super restrictive and that will ask you to write that off so that you cannot charge the patient. If you are not in one of those plans, typically this is something that can be billable to the patient. I don't see really high dollar amounts when it comes to these particular procedure codes but you have to make sure that it is reflective of how much time and energy you spend on this. Some of you are spending a lot of time cleaning them. Some of you have a system set up where you have somebody else in the office clean them. You really have to take a look at how much time and effort and materials this is costing you and make sure that you price yourself appropriately. The interesting part about these particular codes is it really doesn't tell you whether it's implant or abutment supported any of these procedures could be of course natural teeth adhering to natural teeth or they could be attached to an implant. It doesn't really say that in there so you're going to need to make sure that it's noted in the clinical notes what situation that you're dealing with.