Thank you, Tom, for the quick reply. I can see that it's not as
simple as my initial thought. It really depends upon what 837 IG any
given provider of care decides to use, be they a Dentist (837D), Oral Surgeon
(837P? or 837D?), or an Institutional Provider (837I) billing for dental
services... So we MAY receive the claim on anyone of the three. I've
followed some of the exchange of emails that Ruth
Tucci-Kaufhold has participated in. I'll
be checking up on her results....
Again, thank
you.
Jim Moores
HIPAA Team Leader - Privacy - PAIV Antares Management Solutions [EMAIL PROTECTED] Phone: (216)292-1605 Fax: (216)292-1619 >>> [EMAIL PROTECTED] 08/15/01 09:59AM >>> 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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- When Should You Use CDT-3 Codes vs HCPCS Level 2 "D"... Jim Moores
- RE: When Should You Use CDT-3 Codes vs HCPCS Level 2 &qu... Tom Drinkard
- Jim Moores
