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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