Hi Bruce,
If the addenda gets approved the use of modifiers will only be allowed if they are approved by the ADA (and there are currently none). You can not use the HCPCS modifiers in the 837 Dental because the 837D does not allow the submission of HCPCS codes. It is very specific in limiting the procedure codes to 'code value AD' of code set 135 (page 266 of imp guide), and this represents the ADA codes or CDT. Since it does not reference HCPCS, the imp guided does not support HCPCS modifiers after the addenda is approved.
If the addenda is not approved then you can use whatever modifiers you want, since the implementation guide does not specify what type or contain any limitations on their usage. It modifier simply states 'This identifies special circumstances related to the performance of a service, as defined by trading partners.' Keep in mind that even if the addenda is not approved this oversight will eventually be removed.
It gets a little fuzzy when you talk about receiving ADA codes (CDT-3) in an 837 Professional. Since ADA codes are named in the HCPCS codes you can use them on the 837 P, and it is also implied that modifiers are interchangeable within the HCPCS code sets so they are also allowed (this is debatable).
There is currently a lot of discussion regarding which implementation guide to use and when to use it. This is the case with the 837D and 837P guides.
Also, I'm fairly confident that the ADA will have a problem with people modifying their proprietary code set. I'm not sure what they plan to do about it in the 837P. CMS/HCFA has a licensing agreement with the ADA, that allows State Medicaid's to use the code set without signing individual agreements. I'm not sure how the agreement specified the use of the CDT-3 code set.
Hope this helps,
_____________________
Jeff Seybold
California Medicaid (Delta Dental)
(916) 861-2506
Email [EMAIL PROTECTED]
-----Original Message-----
From: Bruce Silverman [mailto:[EMAIL PROTECTED]]
Sent: Thursday, January 17, 2002 12:15 PM
To: [EMAIL PROTECTED]
Subject: Dental 837
I'm looking for some assistance on the Dental 837 Procedure Modifiers
(on the service line detail) - SV301
Can someone point me to what values exist for these modifiers and
where I can locate them
Thanks
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