What documentation is needed for D1999?

A detailed report of the procedure, clinical rationale, and any supporting documentation are necessary for billing D1999.

Is prior authorization required for D1999?

It depends on the insurance carrier. Some may require prior authorization, so it's best to check with the insurer beforehand.

How often can D1999 be billed?

Frequency limitations vary by insurer, so it's important to verify with the patient's insurance plan.

Are there common modifiers used with D1999?

Modifiers may be required depending on the specific circumstances of the procedure. Consult with the payer for guidance.

D1999

Unspecified Preventive Procedure - CDT Code Guide

Preventive/Vaccinations

Overview

CDT code D1999 is designated for unspecified preventive procedures that do not fall under any existing specific codes. This code is particularly useful when a preventive service is performed that lacks a precise description in the CDT code set. Dental professionals may encounter situations where a unique preventive measure is necessary, such as an innovative treatment or a patient-specific preventive strategy that does not fit traditional categories. In such cases, D1999 allows for the flexibility to document and bill for these services while ensuring that patient care is accurately reflected. It is essential to provide a detailed report of the procedure performed to justify the use of this code.

When to Use This Code

When a new preventive treatment is administered that lacks a specific CDT code.
For patient-specific preventive measures that are not covered by existing codes.
In cases where a unique preventive protocol is developed for a patient with special needs.
When a preventive procedure is modified significantly from its standard form.
For experimental preventive procedures under clinical trials.

Documentation Requirements

A detailed description of the procedure performed.
Clinical rationale for using an unspecified code.
Patient's consent and understanding of the procedure.
Any supporting clinical notes or images that justify the procedure.
Documentation of outcomes or follow-up plans.
Billing notes indicating why existing codes were not applicable.

Billing Considerations

When billing with D1999, it is crucial to provide a comprehensive report detailing the procedure to avoid claim denials. This code should be used sparingly and only when no other specific code applies. Insurance carriers may require additional documentation or prior authorization. Be aware of frequency limitations and ensure that the procedure is not covered under another code to prevent billing issues.

Related CDT Codes

D1110 D1206 D1208 D1330 D1351

Frequently Asked Questions

No, D1999 should only be used when no other specific CDT code adequately describes the preventive procedure performed.

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