RE: 835D or P for Medicare dental claims?

[Linda McCardel]

Title: Message

The 2003 HCPCS book has a section included "Dental Procedures" and the codes are D0120 through D9999.  The preface states in part:  "This section (codes D0100-D9999) incorporates numeric codes and descriptors from CDT-4, which is copyright ADA.  Participants are authorized to use copies of CDT-4 material in HCPCS only for purposes directly related to participating in CMS programs.  Permission for any other use must be obtained from the ADA."

 

I would say that the CDT codes are part of HCPCS.  However, dentists billing for traditional dental procedures would likely use the 837D.  If a dentist is providing oral surgical procedures which are coded in CPT, then they would have to use the 837P.  The use of the CDT codes in HCPCS could be very helpful on the institutional 837 - for example, if a patient needing routine dental services must be anesthetized (outpatient surgery), then the correct dental procedure code could be reported in addition to the revenue code(s) - this happens often in the MR/DD population. 

 

If a provider were to perform dental procedures as part of a Medicare-covered oral-maxillofacial surgical procedure, and billed on the 837D, then could CMS refuse to process the standard transaction? 

-----Original Message-----
From: Tucci-Kaufhold, Ruth A. [mailto:[EMAIL PROTECTED]
Sent: Tuesday, March 18, 2003 12:15 PM
To: WEDI SNIP Transactions Workgroup List
Subject: RE: 835D or P for Medicare dental claims?

So ... "Thus, the dental codes will be available from two sources: the ADA, and through a licensing agreement between HCFA and the ADA"

 

Really .. what is being said here is that an entity can get the ADA codes via the ADA or via HCFA and that the ADA codes themselves are not "really"(?) part of the actual HCPCS code set?

 

Please clarify.

Ruth Tucci-Kaufhold
HIPAA Systems Analyst

MAHI Co-Founder 
UNISYS Corporation
4050 Innslake Drive
Suite 202
Glen Allen, VA  23060
(804) 346-1138
(804) 935-1647 (fax)
N246-1138
[EMAIL PROTECTED]

-----Original Message-----
From: Tom Drinkard [mailto:[EMAIL PROTECTED]
Sent: Tuesday, March 18, 2003 11:53 AM
To: WEDI SNIP Transactions Workgroup List
Subject: RE: 835D or P for Medicare dental claims?

Cindy,

I do not have access to the HCPCS 2003 manual.

What I was attempting to explain is that the HCPCS code set includes the "ADA" procedure codes, because HHS has licensed the codes from the ADA.

Here is an excerpt from the August 2000 Final Rule on transactions and code sets.  It begins as the last three lines on page 50326 and continues on page 50327.  The initial portion of the response discusses changes to the Dental procedure codes that occurred with the release of the CDT-3 manual.  The rest of the response discusses the fact that the "dental codes will be available from two sources".

 

<< Begin quote >>

Response: The ADA will change the leading ‘‘0’’ to a ‘‘D’’ as proposed.  Many organizations are already using the ‘‘D’’ Codes, which contains the leading ‘‘D,’’ without difficulty, and we expect others to make this transition without difficulty.  Although we did not receive comments that specifically addressed the removal of the dental codes from the HCPCS, general comments about the desirability of more consolidated access to all HIPAA code sets have led us to revise our position on the inclusion of ‘‘The Code’’ in the HCPCS.  Thus, the dental codes will be available from two sources: the ADA, and through a licensing agreement between HCFA and the ADA.

<< End quote >>

Hope this helps.

Tom Drinkard
EDIT, Inc.
[EMAIL PROTECTED]
(678) 795-1251 (voice)
(775) 458-6117 (fax)


-----Original Message-----
From: Fleming, Cindy R [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, March 18, 2003 10:46 AM
To: WEDI SNIP Transactions Workgroup List
Subject: RE: 835D or P for Medicare dental claims?


Tom,
Below you state that the ADA codes are included in HCPCS.  Where is that documented? I have checked the HCPCS 2003 manual and did not find that reference?

Thank you,
Cindy Fleming
Private Programs HIPAA Project Office Coordinator
Arkansas BlueCross BlueShield
[EMAIL PROTECTED]
501-399-3833

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-----Original Message-----
From: Tom Drinkard [mailto:[EMAIL PROTECTED]]
Sent: Thursday, March 13, 2003 2:49 PM
To: WEDI SNIP Transactions Workgroup List
Cc: 'Stanley Nachimson (E-mail)'
Subject: RE: 835D or P for Medicare dental claims?


With respect, I disagree.
While it would be simpler for many if all "Dental" claims used the 837-D, that is not the case. As I understand it, HHS has licensed the Code on Dental Procedures and Nomenclature from the ADA and includes the entire code set in HCPCS. Consequently, the 837-P (and the 837-I, for that matter) fully supports all of the "ADA" procedure codes.

Here are some of the scenarios where an 837-D is more appropriate: .  For predeterminations (aka pre-treatment estimates) .  If missing teeth information must be reported. .  If tooth codes, tooth surfaces or oral cavity areas must be reported. .  If certain dates must be reported (Initial placement date, Appliance Placement Date, etc.)

Here are some of the scenarios where an 837-P is more appropriate: .  To report diagnosis codes
.  To report procedure code modifiers

The above lists are certainly not exhaustive, but are intended to highlight some of the differences between the 837-D and the 837-P. Lack of support for the "ADA" codes is not one of the differences.

Hope this helps.

Tom Drinkard
EDIT, Inc.
[EMAIL PROTECTED]
(678) 795-1251 (voice)
(775) 458-6117 (fax)


-----Original Message-----
From: Fulton, Rick [mailto:[EMAIL PROTECTED]]
Sent: Thursday, March 13, 2003 1:14 PM
To: WEDI SNIP Transactions Workgroup List
Cc: Stanley Nachimson (E-mail)
Subject: RE: 835D or P for Medicare dental claims?


They need to use the 837 D (Dental) transaction

-----Original Message-----
From: Tucci-Kaufhold, Ruth A. [mailto:[EMAIL PROTECTED]]
Sent: Thursday, March 13, 2003 12:32 PM
To: WEDI SNIP Transactions Workgroup List
Cc: Stanley Nachimson (E-mail)
Subject: RE: 835D or P for Medicare dental claims?


I am concerned Medicare would not be compliant. 

How can Medicare state that they won't accept a HIPAA mandated transaction? Isn't Medicare a payer too? 

The ADA codes are not included in the 837-P(at least not in the Appendix C for the v4010 Imp Guide) ... so only those dental codes that are in HCPCS would be available for payment by Medicare?  Could more detail be given on this subject?

Ruth Tucci-Kaufhold
HIPAA Systems Analyst

Co-Founder MAHI
UNISYS Corporation
4050 Innslake Drive
Suite 202
Glen Allen, VA  23060
(804) 346-1138
(804) 935-1647 (fax)
N246-1138
[EMAIL PROTECTED]



-----Original Message-----
From: Kathleen Simmons [mailto:[EMAIL PROTECTED]]
Sent: Thursday, March 13, 2003 6:27 AM
To: WEDI SNIP Transactions Workgroup List
Subject: RE: 835D or P for Medicare dental claims?


That's correct.  Medicare does not cover general dental care, but under our medical benefits, we do pay for treatment of injuries to the mouth area, some of which may be performed by a dentist.  We will not accept the 837-D, only the 837-P.

>>> "Tom Drinkard" <[EMAIL PROTECTED]> 03/12/03 06:11PM
>>> >>>
Diana,
As I understand it, Medicare will not accept the 837D, since Medicare requires the diagnosis code. So, all Dental claims must be submitted on the 837P.

Keep in mind that Medicare processes only 0.25 million Dental claims per year. That really isn't very many claims by Medicare standards.  Since Medicare doesn't really cover Dental procedures, I suspect that the majority of the claims are those things that cross over between Dental and Medical such as high-end Oral Surgery procedures.

Hopefully someone from CMS will chip in and confirm the above.

Tom Drinkard
EDIT, Inc.
[EMAIL PROTECTED]
(678) 795-1251 (voice)
(775) 458-6117 (fax)

-----Original Message-----
From: Diana Lindsley [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, March 12, 2003 5:04 PM
To: WEDI SNIP Transactions Workgroup List
Subject: 835D or P for Medicare dental claims?



We have heard several different requirements, but have not gotten a definitive response.  Hopefully, someone on this list will know.  We have heard that Medicare will require the 837P transaction for dental claims, which doesn't make much sense to us.  We have also heard that the 837D can be used.  Does anyone know which will be required?

Diana Lindsley

Project Manager

First Pacific Corp.

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