Have you started a root canal on a patient and had to refer them to a specialist for completion? Dr. Joan has the answers to your questions on how to bill out treatment.
I frequently get questions about how to bill out treatment for patients that come in on an
emergency basis due to pain. Let’s assume in this situation, the dentist evaluates the patient,takes a radiographic image and determines they should start root canal therapy. Once the tooth is opened, the dentist determines it should be referred to a specialist. What do they submit for code documentation?
Well, I always say,
report what you do and do what you report!
I would use the following codes:
- D0140 limited oral evaluation – problem focused
- D0230 intraoral-periapical first radiographic image
And if appropriate:
- D0230 intraoral-periapical each additional radiographic image
- D0230 intraoral-periapical each additional radiographic image
I frequently get asked “what about the D3221 pulpectomy code?. This procedure is provided to alleviate acute pain. To that I say “most carriers would consider this a “temporary restoration or as part of the endodontic procedure” and therefore it would not be eligible for reimbursement benefits. The issue then becomes that the new endodontist needs to evaluate the patient and they code for a D0140 limited exam as well, (which may or may not get benefited depending on the patient’s plan design) take an additional pre-operative radiograph and then perform the treatment using the appropriate endodontic treatment code.