Bruce, In the 837 Dental Claim, there are no data items that allow a coded means of expressing why the work was performed. There are several proposals for enhancements to the claim format that would address this problem, but they will not apply to the initial implementation of the HIPAA-compliant Dental claim. The discussions have focused on things like TMJ therapy and the desire to associate an anesthesia procedure with a specific Dental procedure, but they could easily be extended to include cosmetic vs. restorative treatment. The addition of diagnosis information within the Dental claim would be one way to address these areas.
In the current format, however, I believe that the Notes are the only place within the Dental claim to indicate that why the dentist performed any specific procedure. Tom Drinkard EDIT (678) 795-1251 (voice) (678) 795-1575 (fax) [EMAIL PROTECTED] -----Original Message----- From: Bruce Silverman [mailto:[EMAIL PROTECTED]] Sent: Thursday, January 17, 2002 5:34 PM To: [EMAIL PROTECTED] Cc: [EMAIL PROTECTED] Subject: RE: Dental 837 -Reply Tom Thanks much for the quick response To clarify my understanding of your response, If a dentist is doing a crown for example and it is being done for cosmetic reasons instead of restorative reasons, is the notes section the only place on the 837 that currently exists for this info since the modifiers no longer exist? Am I to then understand that the only way to get the modifier back is to have it included in CDT4? Thanks much Sr. Vice President, Claims & Customer Service Delta Dental Plan of New Jersey, Inc. (973)285-4034 (973)285-4230 Fax [EMAIL PROTECTED] >>> "Tom Drinkard" <[EMAIL PROTECTED]> 01/17/02 04:02pm >>> Bruce, This is an easy question. There are no Dental modifiers. The published implementation guide for the 837 Dental Claim shows that modifiers may be used at the discretion of the submitter. This was actually an oversight that was in earlier versions of the 837 Dental Claim (for example versions 3041 and 3051). These earlier guides allowed many different types of procedure codes in the SV3 segment. In the older guides the permissible values in SV301-1 included HC for HCPCS codes, CJ for CPT codes, and even ZZ for mutually defined procedure codes. The May, 2000 implementation guide for the 837 Dental Claim only allows procedure codes from the CDT manual that is maintained by the ADA. In recognition of this error, X12 has created an addenda to the May 2000 implementation guide that attempts to correct several errors. The addenda has changed the usage note for the procedure code modifiers to be "A modifier must be from code source 135 (American Dental Association) found in the 'Code on Dental Procedures and Nomenclature', if such modifier is available.' Since the CDT-3 manual contains no procedure code modifiers, then none may be used until the CDT manual is changed. Hope this helps. Tom Drinkard EDIT (678) 795-1251 (voice) (678) 795-1575 (fax) [EMAIL PROTECTED] -----Original Message----- From: Bruce Silverman [mailto:[EMAIL PROTECTED]] Sent: Thursday, January 17, 2002 3:15 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 ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request.
