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Back  RFI # 978: 837 Dental Modifiers

Formal vs. Informal Help Informal Formal

Submitter

Mary Tyra

Description

SV3 Dental Service, Loop 2400 has a situational rule in SV3010-3 - SV301-6 that states that a modifier is required when 'a modifier clarifies or improves' the reporting accuracy of the procedure code. Below the Situational Rule there is a note that states "A modifier must be a HCPCS modifier or from code source 135 (American Dental Association) found in the 'Code on Dental Procedures and Nomenclature'."

After reviewing Code Source 135, the 2009/2010 Current Dental Terminology from the ADA, we are unable to find modifier list in Code Source 135 please advise as to where they will be found.

Submitter Assigned Keywords

Dental SV3 5010 Code Source 135

Response

Currently, there are no dental proc code modifiers. The data element “Procedure Modifier” in the 837D SV3/SVD segments identify circumstances related to performance of the service, defined by trading partners. Based on 005010X224A1 Health Care Claim: Dental (837) Type 1 Errata, situational rule states: Required when a modifier clarifies or improves the reporting accuracy of the associated proc code. This is the first proc code modifier. If not required by this guide, do not send. Also, an errata change in the note below the situational rule to remove reference to HCPCS now says:A modifier must be from code source 135 (Am. Dental Assoc.) found in the “Code on Dental Procedures and Nomenclature”. This is because modifiers are not currently reported with CDT codes on a dental claim; HCPCS codes/modifiers were not approved for use on dental claims and are not mentioned as part of the HIPAA regs as a recognized code set for dental.This reflects potential future development of modifiers by the ADA.
Submission 3/2/2010
Status Date 3/26/2010
Status F - Final
Primary References
Document 005010X224
Section837
Page282
Set ID837
Table2
Loop2400
Segment Position3800
Segment IDSV3
Element Position01
Component Position3
Industry NameDental Service Procedure Modifier