What are “Take Back Codes”?
“Take Back Codes” Insurance companies have the right to reduce a benefit(by taking the money back) for a service if the related service has already been paid on another submittal. For instance, the patient came in for a fractured tooth and a protective resin was performed and billed and paid by the insurance company. A couple of months later the filling fractures and the patient now has a crown placed. Tell the insurance company that the repair was done in “good faith” to help the patient. The insurance company will usually subtract the payment for the resin from the payout of the crown. Or, if a pulpal debridement D3221 is paid but now the tooth needs root canal therapy, the insurance company may “take back” the payment by reducing the amount paid for the root canal therapy. To avoid a denial always send a short narrative explaining the reason for choosing the treatment course.
Dental Billing Tips and News for Pros; Edition #146