Coding
Report Correct Bone Graft
Codes
Large number of claims denials is
due to bone grafts being reported with incorrect codes.
Specifically, the coding for bone grafts being provided in an
extraction site has the highest incidence/occurrence of denials.
In order to alleviate claims
denials, please remember the following when reporting bone
grafts:
- Bone grafts provided to
preserve the ridge should be coded D7953. This code is also
referred to a socket graft and is used when placing a bone
graft in an extraction site.
- Codes D4263 and D4264 should
only be reported when treating a tooth that has periodontal
disease. The tooth must be present in order to report these
two codes.
The ADA procedure code
descriptors offer some guidance on the use of these codes and
should be referenced if you are unsure which code is
appropriate.
Please remember to submit x-rays,
periodontal charting and a diagnosis when reporting bone grafts
provided for periodontal reasons (D4263 and D4264).
Current Dental Terminology © American Dental Association
National Provider
Identifier
As a result of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA), the Final Rule adopting the
NPI as the standard unique identifier for health care providers
became effective May 23, 2005. As of this date, health care
providers became eligible to receive this 10 position,
intelligence-free, numeric identifier assigned by the National
Plan and Provider Enumeration System (NPPES). The goal of the
NPI is to simplify the administration of the health care system
and enable efficient electronic transmission of certain health
information.
All health care providers are
eligible to receive NPIs. HIPAA covered entities, such as
providers completing electronic transactions, must use only the
NPI to identify covered health care providers in standard
transactions by May 23, 2007.
How to obtain an
NPI
Follow the online process at: https://nppes.cms.hhs.gov.
Download the paper application from this Web site. Contact the
NPI enumerator at 1-800-465-3203 or email customerservice@npienumerator.com
