Hello, I am trying to figure out how a facility bills/gets reimbursed for dental services provided in an OP surgical setting-by an oral surgeon that is a DMD or DDS. We have typically used 41899 or other 4XXXX range CPT codes and received minimal if any reimbursement. Now with Medicaid using EAPG’s they provide package payments based on dental services and are looking for the D codes. In the CDT book, many of the D codes have a facility RVU assigned and the professional claim all use the CDT codes on them as the surgeons are dental/credentialed (DMD DDS). I have multi-tiered questions here:
1. Is it non-compliant to have the facility claim and the professional be inconsistent? (CDT versus CPT)
2. For dual eligible beneficiaries, shouldn’t the claims be coded with CDT codes to get the correct denial to cross over to Medicaid? (Currently we get a not R&N or med necess denial which does not let the claim go to a secondary payer)
3. For services that would normally be performed in a dental office under conscious sedation or nitrous (such as multiple extractions or massive caries); shouldn’t the services be billed as dental with CDT codes?

CMS has D codes on the hospital OPPS addendum B with status indicators showing blank (not recognized), E (exclusion) or other indicating questionable or possibly payable; so I am thinking the D codes are allowable on a UB?

I know this is a lot and any help is appreciated!!!!