Insurance: Q&A

Insurance Paid on a Different Code Than You Charted. Now What?

Ins paid diff code

You’ve charted and completed bitewings (D0272 / D0273 / D0274)¬†and a pano (D0330) for your patient, along with a few other procedure codes. You’ve submitted your claim, and you finally receive the insurance payment.

But what’s this? The insurance paid on a different code. They’re paying based on a Full Mouth X-Ray (FMX) code (D0210) instead of the procedures you charted. Now what?

Here’s our recommendation.

  1. First, you’ve charted and set complete the procedures that were done, so there is no need to delete these or re-chart anything else. It is fairly common for an insurance company to “remap” a submitted code(s) to another code for payment purposes. That does not change the charted procedures that were determined by the dentist to meet the needs of the patient.
  2. Allocate the insurance payment appropriately across the multiple codes you charted.
    If you’re receiving payment of $150 for the FMX and the charted xray procedures are for $60 and $100 for example, make sure to allocate payment accordingly so you don’t create an insurance over-payment on any one procedure code.
  3. Put a note in the “Remarks” column that the insurance paid based on FMX code D0210. This will leave a record of how insurance paid, and if needed, prompt a look at the EOB.
  4. Finalize the payment as usual, scanning your EOB to attach it to the check.

insurance paid different code

Questions about this process? Give us a call – we’re here to help!

 

 

 

Sources:

Practice Booster Code Advisor: Intraoral – Complete Series of Radiographic Images

RDH Magazine: ADA Guidelines, Coding, & Benefits for Radiographs

 

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