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Thursday Troubleshooter: Confusion with dental code D4355

from Dentistry IQ

Dentistry IQ answers the question: "I’m writing about code D4355. We’ve got an Explanation of Benefits (EOB) that states, 'Full mouth debridement is a covered benefit if rendered by itself, in conjunction with, or within 36 months of a limited oral evaluation, nutritional and tobacco counseling, oral hygiene instructions, radiographic images, adjunctive prediagnostic tests, palliative treatment, or after-hours office visits. Full mouth debridement (FMD) will not be covered if any other preventive, diagnostic, or periodontal service has been performed on the same day or within the previous 36 months.' What the heck? If we do a D0150, and the doctor recommends FMD, it can't be done for 36 months? This makes no sense. How could FMD be coded to be paid for services needed and rendered?" more

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