Documentation Requirements
This list is intended to be used as a guide in the submission of electronic attachments. This does not preclude WDS from requesting additional documentation when necessary.
Procedure Code |
Documentation Reqiurement |
Procedure Code |
Documentation Reqiurement |
Procedure Code |
Documentation Reqiurement |
| D0472 |
Pathology report |
D4210 |
Perio chart 1 |
D7288 |
Pathology rpt |
| D0473 |
Pathology rpt |
D4211 |
Perio chart 1 |
D7411 |
Pathology rpt |
| D0474 |
Pathology rpt |
D4240 |
Perio chart 1 |
D7412 |
Pathology rpt |
| D0475 |
Pathology rpt |
D4241 |
Perio chart 1 |
D7413 |
Pathology rpt |
| D0476 |
Pathology rpt |
D4245 |
Perio chart 1 |
D7414 |
Pathology rpt |
| D0477 |
Pathology rpt |
D4249 |
X-ray and narrative |
D7415 |
Pathology rpt |
| D0478 |
Pathology rpt |
D4260 |
Perio chart 1 |
D7440 |
Pathology rpt |
| D0479 |
Pathology rpt |
D4261 |
Perio chart 1 |
D7441 |
Pathology rpt |
| D0480 |
Pathology rpt |
D4274 |
Perio chart 1 |
D7450 |
Pathology rpt |
| D0481 |
Pathology rpt |
D4381 |
Perio chart 1 |
D7451 |
Pathology rpt |
| D0482 |
Pathology rpt |
D4999 |
Narrative |
D7460 |
Pathology rpt |
| D0483 |
Pathology rpt |
D5899 |
Narrative |
D7461 |
Pathology rpt |
| D0486 |
Pathology rpt |
D5999 |
Narrative |
D7465 |
Pathology rpt |
| D0502 |
Pathology rpt |
D6199 |
Narrative |
D7999 |
Narrative |
| D0999 |
Narrative |
D6973 |
X-ray and narrative |
D8999 |
Narrative |
| D2799 |
Pathology rpt |
D6999 |
Narrative |
D9930 |
Narrative |
| D2950 |
X-ray and narrative |
D7241 |
X-ray and narrative |
D9940 |
Case Type 2 |
| D2962 |
X-ray and narrative |
D7251 |
X-ray and narrative |
D9951 |
Tooth numbers adjusted |
| D2999 |
Narrative |
D7285 |
Pathology rpt |
D9999 |
Narrative |
| D3999 |
Narrative |
D7286 |
Pathology rpt |
|
|
|
1 Perio chart must be no more than 12 months old on the date of service.
2 Only if the group covers occulsal guards for perio only
For claims requiring attachments, Washington Dental Service accepts electronic attachments through FastAttach, offered by National Electronic Attachments (NEA). This means you can submit scanned x-rays, intra-oral photographs, periodontal charts and more when providing supporting clinical documentation for electronic claims. Using electronic attachments can not only accelerate claim processing, but will also eliminate the need and cost to duplicate and mail x-rays and other necessary attachments.
Here's what you will need to utilize FastAttach:
• Pentium processor computer or equivalent
• Monitor with video card capable of 24-bit color
• An internet service provider
• Windows 98, Windows NT 4.0 or higher
• Microsoft Internet Explorer 4.0 or higher
• A way to digitize your attachments (a scanner or digital x-ray system)
For more information about NEA FastAttach, please visit www.nea-fast.com or call (800) 782-5150.