Change Request Detail
No.
1068
Date
3/25/2008
Submitter
Type of Request
Professional Claim (HCFA 1500)
Status
DSMO Process Completed
Business Reason
Several dental providers (oral and maxillofacial surgeons, periodontists, and others) routinely submit claims to medical plans using the 837 Professional Claim.  These providers frequently need to designate the tooth number(s) and/or oral cavity area(s) for the reported procedure.

In order to allow a consistent, codified means for specifying tooth and oral cavity information, please add the TOO segment to the 2400 loop of the Professional Claim.  Note that the TOO segment can easily report a tooth number or an area of the oral cavity, since the tooth numbering system qualifier is part of the segment.

Note also that the CMS-1500 form has been modified to support the designation of tooth numbers / oral cavity areas for individual procedures.
Suggestion
Add the TOO segment to the 2400 loop for the Professional Claim.  It is necessary to report multiple tooth numbers per procedure, so the repeat count for the TOO segment must be greater than one (suggestion: set repeat count to 35 as in the Dental Claim guide.)

The TOO segment would be required when it is necessary to report tooth number(s) and/or oral cavity areas in relation to the specified procedure.
DSMO Category
B
Recommendation
Approve with modification.The DSMO agrees with the suggested change with the exception of the repeat count should be 32 not 35 as submitted in order to match the Dental Guide.
Appeal Recommendation