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14 Cards in this Set
- Front
- Back
What does CDT stand for?
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Current Dental Terminology
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What is the purpose of CDT codes?
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To achieve uniformity, consistency & specificity in accuratel reporting dental Tx.
*One use of the CDT codes is to provide for the efficient processing of dental claims.* |
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What does HIPAA stand for?
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Health Insurance Portability & Accountability Act
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HIPAA requires proper reporting of dental codes.
What are some examples of Dental Fraud? |
Billing for services not provided
Reporting a higher level of dental service than was actually performed-->"Up-Coding" Submitting a dental claim under one Pt's name when services were provided to another person. Billing for non-covered services as if they were covered. Performing services that are not suitable or necessary. |
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Codes ending in 99 of 999 are _____-__________--.
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non-specified "D4999"
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If you're using a non-specified code what do you need to do when submitting for billing?
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Include a narative,
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What are the components of a code entry?
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Procedure code-->5 Character alphanumeric beginning with D
Nomenclature-->Written title of the procedure. Descriptor-->Narrative providing further definition & intended use of the procedure. (Most but not all codes have a descriptor.) |
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What are 5 services that are usually not covered by insurance?
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1) Intra Oral Photo's-->except as part of an ortho record component.
2) Caries susceptibility-->saliva testing 3) Smoking Cessation Counseling 4) Nutritional Counseling for control of dental diseases 5) OHI |
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If a difficult class I or II Pt comes in for Tx that hasn't been seen in a while, how might the DDS bill for this PT who takes more time?
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They can bill for highter fee for 1 long appt or they can bill the D1110 code twice if its handled in 2 appts…but its not ususally covered.
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How are sealents usually billed?
Which teeth are always vs sometimes covered? |
Sealents are billed per tooth.
Molars are always covered. PM's are sometimes covered. *Remember sealants are usually only covered up to a certain age on the Pt.** |
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Why is the Full Mouth Debridement code of D4355 considered a 4 letter word in DH?
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Because its only used if teeth have so much calc on them that it interferes with the ability of the dentist to perform a comprehensive exam.
*Typically once the supra Calc is removed then actual data (Perio measurements etc) can be taken. Pt feels their teeth are clean since they can't see the Sub G calc and they don't return for the next appt to have it all removed.* **Its better to work one quadrant at a time, get the data and then move to the next quadrant to ensure PT compliance.** |
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If Arestin (D4381) is going to be provided when is the best time to provide it and get reimbursed for the service?
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At the 6 week re-eval.
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If using the code 4999 for Chlorhexidine use after SRP, what might need to be included with the billing?
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A narrative.
*Remember, any code ending in 99 or 999 probably is going to require a narative.* |
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Can Pt's be considered both a D4910 Periodontal maintenance & a D1110 Prophylaxis adult over 14?
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NO!
They are not interchangeable codes. The PT is either one or the other. If the PT heals and becomes a D1110 but would need to be Scaled & Root planed again in order to code as a D4910 again. |