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Doctor's office using the wrong treatment code. How can I get them to correct it?

The code being used is for pulpotomy which is wrong. I spoke with them and they sent me to the insurance company, who sent me back to the dr office. What can I do?


Asked by Anonymous at 6:56 PM on Jan. 25, 2010 in Health

This question is closed.
Answers (10)
  • ok i did this with mine for over a year. by law the insurance company cannot tell the office which code to resubmit it as. so until they get the correct code entered and submitted, the insurance company is tied up. i finally threatened to sue if they didnt figure it out because after a certain period of time there is a clause in our insurance that says past that time i am responsible for the payment. sooo...i gave both of them the same ultimatum...figure it out or talk to my lawyer. the office may not understand why the code is wrong, but keep hounding them. sometimes it truly is a misunderstanding. billing is definitely a place to start ,but sometimes it is the office submitting the wrong item to billing. trace it down the line! good luck!!

    Answer by FoxyRoxyMommy at 11:39 PM on Jan. 25, 2010

  • Ask to talk to billing

    Answer by mommymeg03 at 6:56 PM on Jan. 25, 2010

  • That's weird, a pulpotomy is when the inflamed pulp chamber, usually on a baby molar, is removed. Isn't that usually done in a dental office rather than a Dr.'s office? They should be able to change it to the correct code.

    Weren't you asking before about wanting to change the code from the code for the procedure you had to a different code so your insurance would cover it? I'm not sure that you can do that.

    Answer by Anonymous at 7:09 PM on Jan. 25, 2010

  • The doctor's office has to resubmit with the correct code. The insurance co can only accept or reject the code the dr office sent them. They were wrong for telling you to go to the insurance co. If they want to be paid they need to resubmit with the correct code!

    Answer by admckenzie at 7:09 PM on Jan. 25, 2010

  • this is the dr's office job. sometimes people like to pass the buck. call the office again, and ask again, and if you get the run around again ask to speak to someone in charge. they are the ones that won't get paid...unless you paid up front and are waiting for reimbursement. if this is your $ they are sitting on, tell them you will charge them interest and collection fees for neglecting the matter.
    good luck!

    Answer by happy2bmom25 at 8:29 PM on Jan. 25, 2010

  • What is the exact code being used? Is it a CPT code or HCPCS code? Where did you find it was a pulpotomy? The procedure you should use is this:

    Contact the DOCTOR: NOT THE OFFICE. ONLY THE DOCTOR CAN CHANGE THE CODE and resubmit. The office is NOT ALLOWED to change the code UNLESS the doctor doesn't do his own coding. (Which would be weird.) What procedure was actually done?

    Answer by Anonymous at 2:20 AM on Jan. 26, 2010

  • Did you have a root canal done? A pulpotomy is the first step and is usually not billable separately.

    Answer by Anonymous at 2:23 AM on Jan. 26, 2010

  • sorry for the late response. I got the information from the proposed treatment plan. this is what they wanted to do. but my understanding was just caps/crowns on the teeth. so when they gave me the proposed treatment plan, i was told to go to the insurance company and see if its covered. so i did and that's when it was implied that maybe its' the wrong code. so googled pulpotomy and found out it's not what we discussed. the dentist's office keep sending me back to the insurance. after googling i found out about cpt and hcpcs codes.


    Answer by Anonymous at 8:17 AM on Jan. 26, 2010

  • i don't think you need the exact codes when talking to your insurance company, since this is all before the fact. just find out exactly what procedures will be done, and then you should be able to look it up in your benefits book...or call the customer service # on the back of your card. be sure that if you talk to anyone that you take their name, write down the date and time of the call as well. if someone from benefits at the insurance company misquotes you, then they are still liable for payment...unless when they quote you there is an "out" clause for them. you can also request that the call be recorded, and then if there is a misquote, it may be easily cleared up. i don't know why insurance co's make things so difficult! it should be so cut and dry...either your policy will cover caps and crowns or it won't.

    Answer by happy2bmom25 at 1:39 PM on Jan. 26, 2010

  • ok, on second thought...
    ask your dental office to call the insurance company...they both speak the same language!!!!
    if your dental office won't do it, there are a ton that will!
    good luck!

    Answer by happy2bmom25 at 1:40 PM on Jan. 26, 2010

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