Gary,

You are correct that the topic of which form to use is a guess in some situations.

 There are other factors to consider as well.

 

Here are some other factors to consider when deciding which transaction to build for Oral Surgery services.

  1. If you need to specify procedure code modifiers, the 837D (as of the Addenda) no longer supports them.
  2. If your procedure coding scheme is based on CPT codes, then you cannot use the 837D, since it only supports CDT codes.
  3. If you need to specify tooth number(s), tooth surfaces, and/or oral cavity areas, you must use the 837D.  The 837D is the only transaction that supports these data items.
  4. The target health plan and/or clearinghouse may be a factor.  Some health plans will accept and return an electronic claim if it is in the ‘wrong’ format as defined by the health plan

 

I would respectfully disagree with the comment that “since dental providers use the proprietary 1500 format, so to speak.  It has been my experience that few dental offices (outside of the hospital setting) use any format other than the 837D.  Inside of the hospital, there is a strong case to use the 837P, since the systems in place can handle (or will be able to handle) that format already.

 

Interesting topic.

 

Tom Drinkard

EDIT, Inc.

(678) 795-1251

 

-----Original Message-----
From: Tolin, Gary T. [mailto:[EMAIL PROTECTED]]
Sent: Monday, November 11, 2002 4:32 PM
To: WEDI SNIP Transactions Workgroup List
Subject: Medical Dental Claims and IG selection
Importance: High

 

Group:

 

I read through the Implementation Guide Selection white paper draft, dated 11/5/02.  This paper regarded the health care industry's current billing methods, and explained how these affect which HIPAA Implementation Guide may be used when billing for specific health care services.  We at Oxford are trying to determine whether to build an 837D for Oral Surgery services.

 

The survey included within the paper illustrates what we have been discussing-that the dental provider may either submit and 837P or 837D for an oral surgical service.  More to the point, there isn't any billing consistency now and may not be in the future.

 

From my point of view, the place of service (POS) and provider should determine what transaction should be submitted.  If the POS is 21 and the facility is billing, and 837I should be used.  If the Oral Surgeon is billing, use and 837P.  For regular dental services  (bitewing, prophylaxis, etc.) use an 837D.  However, the survey suggests perhaps using an 837P would be a more suitable format, since dental providers use the proprietary 1500 format, so to speak.

 

Please let me know your thoughts as to the above.

 

Thank you for your consideration and responses.

 

Regards,

 

Gary Tolin

Oxford Health Plans

HIPAA Project Manager

Internal:204-7301

External:  800-889-7658, x. 7301

e-mail:  [EMAIL PROTECTED]

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The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time.

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