Code Tip: Question and Answer

Code Tip: Question and Answer

Question:

I have an office that has billed D7511 on the same day as service as D7210 both #21

Humana has denied D7511 and stating we can not balance bill the patient due to Procedure submitted is inclusive to another procedure.

Has the office billed this procedure incorrectly or can this be appealed with additional narrative.

Answer:

Most plans will not pay for an I&d and extraction on the same day and I usually write off the I&D. Unless the I&D was performed in a completely different area of the mouth, in this case you will need to specify the area and send in with a narrative.

eAssist Helpful News and Billing Tips; Edition #115

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