Guest guest Posted May 8, 2012 Report Share Posted May 8, 2012 Every once in awhile one of my patients will come in only for tooth pain, because they don't have a dentist. I was always told that we will only get paid if we code for tooth abscess, not tooth pain (that's what we always did at the urgent care and it worked.) I just billed Medicare using 522.5 (periapical abscess without sinus) and it came back " this service is not covered... " . Anyone know if there's a better code to use to get paid? I really try not to see people for this, but on the rare occasion it's needed I'm going to have them sign an ABN first from now on. I'd like to get paid from this recent visit, though. Any thoughts would be appreciated! Gretchen Gretchen Reis MD Wellspring Family Medicine 1171 N Court St Circleville, OH Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2012 Report Share Posted May 8, 2012 Where do you source the fluoride treatment materials? thanks, Ben To: Sent: Tuesday, May 8, 2012 11:25 AM Subject: Re: Coding for dental issue caries 521.0 ? dental disease is huge here Dental issues are the top er issue(Of issues that go to er and should go to an office) mediciad folks mostly so medicaid will pay for that code Also pays me to do fluoride treaments in kids- cost 1.00 ,get paid 12.00, add it to wcc) not sure about the other insurers.BestJean If they have associated lymphadenopathy with their tooth pain, I might code that lymphadenitis. To: Sent: Tuesday, May 8, 2012 8:37 AM Subject: Coding for dental issue Every once in awhile one of my patients will come in only for tooth pain, because they don't have a dentist. I was always told that we will only get paid if we code for tooth abscess, not tooth pain (that's what we always did at the urgent care and it worked.) I just billed Medicare using 522.5 (periapical abscess without sinus) and it came back "this service is not covered...". Anyone know if there's a better code to use to get paid? I really try not to see people for this, but on the rare occasion it's needed I'm going to have them sign an ABN first from now on. I'd like to get paid from this recent visit, though. Any thoughts would be appreciated! Gretchen Gretchen Reis MD Wellspring Family Medicine 1171 N Court St Circleville, OH -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2012 Report Share Posted May 8, 2012 I use varnish america I got " trained " at an AAFp mtg 2-3 yrs ago--does not take much MaineCAre here really encourages it becasue you help kids who cannot get to a dentist also cavity shield or others www. kohp.org v72.2 dental exam without without physical exam( maine care tells me touse that) and 521.09 caries unspecified if caries is presnet or just v20.2 and in section 24 of the hcfa 24 D is D1206 and I charge 12.00 becasue that is what maine care pays Ihave an oocasional blue cross fmaily that I charge 24.00 for The stuff paints on and tastes like bubble gum Where do you source the fluoride treatment materials? thanks, Ben To: Sent: Tuesday, May 8, 2012 11:25 AM Subject: Re: Coding for dental issue caries 521.0 ? dental disease is huge here Dental issues are the top er issue(Of issues that go to er and should go to an office) mediciad folks mostly so medicaid will pay for that code Also pays me to do fluoride treaments in kids- cost 1.00 ,get paid 12.00, add it to wcc) not sure about the other insurers.BestJean If they have associated lymphadenopathy with their tooth pain, I might code that lymphadenitis. To: Sent: Tuesday, May 8, 2012 8:37 AM Subject: Coding for dental issue Every once in awhile one of my patients will come in only for tooth pain, because they don't have a dentist. I was always told that we will only get paid if we code for tooth abscess, not tooth pain (that's what we always did at the urgent care and it worked.) I just billed Medicare using 522.5 (periapical abscess without sinus) and it came back " this service is not covered... " . Anyone know if there's a better code to use to get paid? I really try not to see people for this, but on the rare occasion it's needed I'm going to have them sign an ABN first from now on. I'd like to get paid from this recent visit, though. Any thoughts would be appreciated! Gretchen Gretchen Reis MD Wellspring Family Medicine 1171 N Court St Circleville, OH -- MD ph fax -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2012 Report Share Posted May 8, 2012 Gretchen, this happened to me, too. We called Medicare and were told they do not pay for anything to do with teeth. So now I treat things like " jaw pain " 784.92, " other acute pain " 338.19, or " atypical face pain " 350.2. Gee, I wonder what " typical face pain " is? I haven't had trouble over this with any other payers.---Sharlene > > Every once in awhile one of my patients will come in only for tooth pain, because they don't have a dentist. I was always told that we will only get paid if we code for tooth abscess, not tooth pain (that's what we always did at the urgent care and it worked.) > > I just billed Medicare using 522.5 (periapical abscess without sinus) and it came back " this service is not covered... " . Anyone know if there's a better code to use to get paid? > > I really try not to see people for this, but on the rare occasion it's needed I'm going to have them sign an ABN first from now on. I'd like to get paid from this recent visit, though. Any thoughts would be appreciated! > > Gretchen > > Gretchen Reis MD > Wellspring Family Medicine > 1171 N Court St > Circleville, OH > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.