From: Subject: =?Windows-1252?Q?HOW_TO_CLAIM_FROM_THE_MEDICAL_AID_=96_2006_NRPL_GDP_Fees?= Date: Wed, 17 Jan 2007 21:27:50 -0000 MIME-Version: 1.0 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: file://C:\Documents and Settings\Rana Muller\My Documents\Websites\STICK BOND DENTAL\HOW_TO_CLAIM_2007.htm X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.3028 HOW TO CLAIM = FROM THE MEDICAL AID =96 2006 NRPL GDP Fees

 

Stick Bond=20 Dental

HOW TO CLAIM FROM THE = MEDICAL=20 AID =96 2007

 

 

1.        =20 SECTION 1: SPLINTING

 

Periodontal splint=20

Diagnostic=20 code: K05.3

Clinical = codes:  8768 (per tooth) R201.70 = X=20 6

No=20 Perio benefits: 8352x2, 8353x4=20

           =20

TOTAL PERIO SPLINT =20 R1210.20

 

No = Perio benefits:

DENIS:=20 R1230.00

Other:=20 R1266.00

 

 

Orthodontic=20 Permanent Retainer

Diagnostic code: = K07.3 (or=20 original treatment code)

Clinical = code:  8849 +L       =20 R=20 212.00

Lab=20 codes:

9301 (model)             &n= bsp;     =20    R  = 19.00

9327 (infection=20 control)      =20 R   13.00

9617 (invisible=20 retainer)       = R=20 111.00

9758 (cost of = fibre)           &n= bsp;=20 R 180.00

9760 (cost of=20 composite)    =20 R 120.00

Total Lab = (8099)           &nbs= p;   =20 R 443.00

 

TOTAL Clinical + Lab     R=20 655.00

 

DENIS: = 8849 pay only=20 R202.00+L

 

Fixed = Space=20 Maintainer

Diagnostic = code(s): K00.5/9;=20 K08.1; K01.0

Clinical code: = 8173 x 2 (per=20 abutment)+L         =20           =20            &n= bsp;        R=20 248.00.00

Lab=20 codes:    =20

9301 (model)          =20 R  =20 19.00

9327 (infection=20 control)      =20 R  =20 13.00

9572 (basic = charge)           =20 R  122.00

9622 (space maint./arch)     R   = 44.00

9758 (cost of = fibre)           &n= bsp;=20 R =20 120.00

9760 (cost of=20 composite)    =20 R  =20 55.00

Total lab = (8099)           &nbs= p;    =20 R 373.00

 

TOTAL Clinical + Lab  R=20 621.00

 

DENIS: = 8849 pay only=20 R118.00 (per abutment)+L

 

 

Occlusal = splinting

Diagnostic = code(s);=20 K02.1/K05.3

Suggested med. aid = codes:=20 8370 or 8369 or 8768

Fee according to = clinical=20 code

Cost of everStick Perio = fibre material: =B1 1 cm fibres (splint) =3D =B1 R 100.00 =

Consider creating = own code=20 (COF1) value =B1 R 125.00 (Patient=20 to pay)

 

 

 

Trauma=20 Splint

Diagnostic=20 code: S03.2

Recommended = fee           &nbs= p;            = ;            =             &= nbsp;   =20            &nbs= p;      =20 R 636.00

Suggested med. Aid = codes=20 8768 (per tooth) R 212.00X 3

Each additional = tooth           &n= bsp;           &nb= sp;          =20            &n= bsp;           &nb= sp;           &nbs= p;  R = 212.00

No=20 Perio benefits: consider=20 8352/3

 

 

2.           = ;      =20 SECTION 2:=20 POSTS

 

Anatomical Fibre Post

Diagnostic codes: = K04.2/3;=20 K02.1/8

Clinical codes: = 8345 + 8379=20 (r007)           &nbs= p;            = ;            =             &= nbsp;=20 R 316.60

8379: Cost per = post =3D R=20 130.00 + 8025 (R 26.00) =3D R156.00

DENIS: benefit = 8345 =3D  R 125.00=20 only

 

Anatomical post = and=20 core

Diagnostic codes: = K04.2/3;=20 K02.1/8

Clinical codes: = 8376 + 8379=20 (r007)           &nbs= p;            = ;            =             &= nbsp;=20 R 521.00

Add=20 code 8355/8409+L depending on rest of the = procedure

DENIS: benefit = 8376 =3D R=20 346.00

Note: = Code 8379 is paid = =91by=20 arrangement=94.  Not = all funds=20 pay for it

 

 

3.           = ;      =20 SECTION 3:=20 DIRECT BRIDGES

 

Direct Bridge=20 (Remember to take an impression)

Diagnostic codes: = K08.1/9=20 (congenital)

Clinical codes: = Retainers:=20 8383 x 2           &n= bsp;           &nb= sp; =20 R 1190.00 (DENIS no benefit)

           &n= bsp;         =20 Pontic: 8415+ L (Rule 007) =               R  625.00 (DENIS R=20 500.00)

Lab=20 Codes:    = 9301=20 (model)           &nbs= p;       =20    R    19.00

 9327 (infection = control)      =              R   =20 13.00

            &nbs= p;     =20  9524 x 2 = (comp=20 inlays)            <= SPAN=20 style=3D"mso-spacerun: = yes">         R  = 280.00

 9557  Indirect comp cr/pontic       =     R  = 498.00

 9758  Cost of fibres           &n= bsp;           &nb= sp; =20 R =20 250.00

 9760  Cost of composite           &n= bsp;  =20     R  = 160.00

 Total lab (8099)           &nbs= p;   =20            &n= bsp; R=20 1220.00

TOTAL Clinical + = Lab           &nbs= p;            = ;            =    =20 R3035.00

DENIS = retainer code 8437=20 r007

Additional Codes=20

Attaching the = fibre: 8352/3 per retainer (direct acid = etch), rule=20 007 apply (?ICD10 not compatible =96 cannot use filling code for=20 retainer))

Or

8436/7 (Retainer, = inlay,=20 porcelain) or 8432/3 (Retainer inlay, metal) rule 007=20

Or

8382/3 (Retainer, = inlay,=20 resin) modifier 8023 =96 no lab state 8099(m8023) value =3D 25% of = value=20 8382/3 (Recommended code)

     =20 Or

8617 (Maryland type=20 retainer) rule 007 and possibly modifier 8023 apply

 

 

 

4.           = ;      =20 REINFORCING=20 HUGE COMPOSITE RESTORATIONS

 

Reinforcement of=20 large composite restorations

Diagnostic code: = K02.1           &nbs= p;            = ;            =          =20

Clinical codes:=20 8354/8370           &nbs= p;            = ;            =             &= nbsp;           &n= bsp;=20 R =20 284.00

Charge for fibres: 8347/8348 or your own code COF1 = (cost of fibres)     R  = 135.00

TOTAL           &nbs= p;            = ;            =             &= nbsp;           &n= bsp;           &nb= sp;           &nbs= p;           =20 R  419.00

Recommended charge = for fibres =B1 R125.00

DENIS: 8370 = =3D=20 R275.00

 

5.           = ;    =20 Indirect = Techniques - LAB=20 CODES

 

INDIRECT = CROWN=20

Diagnostic=20 codes: K02.1; K03.0; K03.9

Clinical=20 code: 8409+L           &nbs= p;            = ;    =20 R  765.00 = (DENIS R=20 720.00)

Lab=20 codes:

9301=20 Model           &nbs= p;            = ;        =20 R   =20 19.00

9315=20 C&B Model           &nbs= p;            = ;  =20 R   =20 79.00

9319=20 Extra die           &nbs= p;            = ;    =20 R   =20 18.00

9320=20 Pindex           &nbs= p;            = ;       =20 R   =20 18.00

9327 x 2 Infection = control           &nbs= p; =20 R   =20 26.00

9330 Delivery = charge           &nbs= p;       =20 R   =20 36.00

9557 Indirect comp = cr/pontic        =20 R  498.00

9758 Cost of fibre           &n= bsp;           &nb= sp;=20 R  =20 150.00

9760 Cost of = composite           &n= bsp;    =20 R   =20 60.00

Total Lab = (8099)             &n= bsp;            = R=20  904.00

TOTAL           &nbs= p;            = ;            =             &= nbsp;           &n= bsp;      =20         =20 R 1669.00

 

 

Indirect Bridge=20 Construction

Diagnostic codes: = K08.1/9=20 (congenital)

Clinical codes: = retainer=20 8382/3, pontic 8415 +L (Fee according = to=20 clinical code)

Lab=20 codes:

9301=20 Model           &nbs= p;            = ;        =20 R   =20 19.00

9315=20 C&B Model           &nbs= p;            = ;  =20 R   =20 79.00

9319=20 Extra die           &nbs= p;            = ;    =20 R   =20 18.00

9320=20 Pindex           &nbs= p;            = ;       =20 R   =20 18.00

9327 x 2 Infection = control           &nbs= p; =20 R   =20 26.00

9330 Delivery = charge           &nbs= p;       =20 R   =20 36.00

9524 Indirect comp = inlay x 2=20          R  = 280.00

9557 Indirect comp = cr/pontic        =20 R =20 498.00

9758 Cost of fibre           &n= bsp;      =20     =20 R =20 250.00

9760 Cost of = composite           &n= bsp;    =20 R =20 160.00

Total Lab = (8099)           &nbs= p;            = ; =20 R 1384.00

 

LAB FEES FOR = 3-UNIT=20 BRIDGE   = DENIS retainer = code 8437 r=20 007

 

 

Indirect=20 Anatomical Fibre = Post

Diagnostic codes: = K04.2/3;=20 K02.1/8

Clinical=20 codes: 8581+L (r007)           &nbs= p;            = ;   =20 R  226.00=20

Lab=20 codes (8099):

9301=20 Model           &nbs= p;            = ;        =20 R   =20 19.00

9315=20 C&B Model           &nbs= p;            = ;  =20 R   =20 79.00

9319=20 Extra die           &nbs= p;            = ;    =20 R   =20 18.00

9320=20 Pindex           &nbs= p;            = ;       =20 R   =20 18.00

9327 x 2 Infection = control           &nbs= p; =20 R   =20 26.00

9330 Delivery = charge           &nbs= p;       =20 R   =20 36.00

9545 Post           &nbs= p;            = ;          =20 R =20 255.00

9535 Coping           &nbs= p;            = ;       =20 R =20 358.00

9758 Cost of fbre post material      =20 R =20 160.00

Total Lab = (8099)        =20            &nbs= p;    =20 R  969.00

TOTAL Clinical + = Lab           &nbs= p;            = ;            =             &= nbsp;         =20 R 1195.00

 

 

 

 

 

Other applicable clinical codes:

 

Section = 5:  Indirect bridges -=20 retainers

 

Retainer full cover (crowns) code 8443 (r007) = corresponding=20 lab code 9557

Retainer Maryland: code 8617 corresponding = lab code=20 9524, report pontic 8415 r 007

 

 

 

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