Revisions to the American Dental Association?s Common Dental Terminology (CDT) code set for 2016 have changedthe way anesthesia services are reported. Previously, anesthesia codes were reported on one line of service for eachunit billed, resulting in multiple line items when more than one unit of anesthesia was required. Anesthesia servicesthat include multiple units should now be reported on one line, streamlining claims submission. The AmeriHealthclaims processing system was updated to calculate anesthesia codes by the number of units used when billed on asingle line of service. Billing and adjudication changes became effective May 13, 2016, for the following CDT codes:
- D9223: Deep sedation/general anesthesia ? each 15 minute increment (implemented January 1, 2016);
- D9224: Intravenous moderate (conscious) sedation/analgesia ? each 15 minute increment (implementedJanuary 1, 2016).
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Paper claims
The following tables show examples of completing Box 24 on the CMS-1500 claim form:
Before 5/13/2016
A. Date(s) ofService
MM/DD/YY
MM/DD/YY | B. Place ofService | C. EMG | D. Procedures,Services, OR Supplies(Explain UnusualCircumstances)
CPT®/HCPCS | Modifier | E. DiagnosisPointer | F.$ Charges | G. DaysorUnits |
|---|
| 01/01/16 | 11 | | D9223 or D9224 | | $50.00 | 1 |
| 01/01/16 | 11 | | D9223 or D9224 | | $50.00 | 1 |
After 5/13/2016
A. Date(s) ofService
MM/DD/YY
MM/DD/YY | B. Place ofService | C. EMG | D. Procedures,Services, OR Supplies(Explain UnusualCircumstances)
CPT®/HCPCS | Modifier | E. DiagnosisPointer | F.$ Charges | G. DaysorUnits |
|---|
| 01/01/16 | 11 | | D9223 or D9224 | | $100.00 | 2 |
Electronic claims
The following examples show how claim submissions appear through Electronic Data Interchange:
Please share this information with your billing vendor or trading partner to ensure proper system updates. If you haveany questions about these changes, please contact your Provider Partnership Associate or Network Coordinator.