Jim, The “Bundling
with COB Example” on page 22 of the Dental Implementation Guide is misleading. It shows
SV2 segments which are a part of the Institutional claim. This may
have been copied from the Institutional guide and not revised for Dental
claims. When using
the Dental Implementation Guide (004010X097), you have no options. You must
use the CDT-3 codes. When
submitting a Professional claim (004010X098) or an Institutional claim
(004010X096), one of your options is to use the HCPCS codes. Since the
HCPCS codes include the entire set of CDT-3 codes, this can be confusing. There is
an effort underway, spearheaded by Ruth Tucci-Kaufhold ([EMAIL PROTECTED]) that is attempting to resolve the
question of when to use which implementation guide. Below is a snippet outlining their intent to develop a white
paper on this topic. One thing that may help you to decide
which claim format to use is to note that only the Dental Implementation Guide
contains data items such as Tooth Number, Oral Cavity Area, Date of Prior
Placement (of crown/bridge), Orthodontic Treatment Months Remaining, etc. If you need to send/receive this
information, you will have to use the Dental Implementation Guide. >> We are asking all payers to help
in the development of >> a WEDi/SNIP White Paper on
"Choosing the Correct >> Implementation Guide for Billing Purposes".
>> This paper will attempt to
outline if a provider has >> a certain service, which Claim
HIPAA implementation >> guide is to be used for the
service to be billed. So, please
pay not attention to the example, since it shows an Institutional claim. Stay tuned
for more information on when to use which claim type for what. Tom Drinkard EDIT (678) 795-1251 (voice) (678) 795-1575 (fax) [EMAIL PROTECTED] -----Original
Message----- Hi All, A question was brought up to me by one of the areas that
process Dental Claims in the company that I work for.... "When do
you have to use CDT-3 and when can you use the HCPCS Level 2 "D"
codes". This in the context of Managed Care Product. I
understand that the codes are functionally equivalent, just replacing the first
digit of the CDT-3 code with a "D". My first answer was... if the procedure happened in a
professional setting, the provider of care must use the CDT-3 code. If
the care is provided in an institutional setting, the provider must use
the HCPCS code. But wanting to be thorough, I went to the 837 Dental
Implementation Guide... I searched on the key words
"procedure", "CDT-3" and "HCPCS". In the
detail the only option given for the code qualifier was "AD"
indicating CDT-3 codes(pages 266 and 304 of the Dental IG). However in
the "Bundling / Unbundling" example in the front of the document, it
used HCPCS code identifiers. I thought that searching the other 837 IG's
wouldn't be of much use, so I searched the FAQ's on the Admin Simp website...
it is silent on the issue. So, I'm throwing this out to the group, to see if we can
get an answer from the manuals (that I missed) or get a consensus on how to
treat the situation. All help would be appreciated..... Jim Moores
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