Expanded benefits for pregnant women are standard with our Delta Dental PPOSM* plans and include the following:

— One (in addition to the patient’s standard benefits) of any of these: D0120, D0140, D0150, D0160, D0170, D0180

— And one of the following:

  • D1110 – 1 additional, or
  • D4341/D4342 – up to 4 quadrants, or
  • D4346 – 1 additional, or
  • D4910 – 1 additional for patients who have completed active periodontal scaling/root planing at least 3 months prior

To help ensure correct processing of the above services (and avoid resubmittals), include an ICD-10 CM diagnosis code for pregnancy from the Z33 or Z34 categories.**

ICD-10 CM diagnosis codes can expedite claims processing when enhanced or additional benefits apply to patients with certain health conditions, such as pregnancy. Most claim forms have a Diagnosis Codes section with space for up to four ICD-10 CM diagnosis codes.

 Tips for using ICD-10 CM diagnosis codes on claims:

  • Use ICD-10 CM diagnosis codes for dates of service on and after 10-1-15. For older dates of service, use ICD-09 CM diagnosis codes. Do not mix codes on claims.
  • For your pregnant PPO patients, enter the ICD-10 CM diagnosis code from the Z33 or Z34 categories that most closely describes the patient’s condition.
  • Submit real-time claims! ICD-10 CM diagnosis codes are automatically validated upon submission.

 

* Our group of Delta Dental companies: Delta Dental Insurance Company (AL, FL, GA, LA, MS, MT, NV, TX, UT) and the Delta Dental companies of California, Delaware, District of Columbia, New York, Pennsylvania/Maryland and West Virginia.

** International Classification of Diseases (ICD) clinical modification (CM) codes for pregnancy:

Z33 Pregnant state:

Z33.1 Pregnant state, incidental

Z34 Encounter for supervision of normal pregnancy:

Z34.0 Encounter for supervision of normal first pregnancy

Z34.00  unspecified trimester

Z34.01  first trimester

Z34.02  second trimester

Z34.03  third trimester

Z34.8 Encounter for supervision of other normal pregnancy:

Z34.80  unspecified trimester

Z34.81  first trimester

Z34.82  second trimester

Z34.83  third trimester

Z34.9 Encounter for supervision of normal pregnancy, unspecified:

Z34.90  unspecified trimester

Z34.91  first trimester

Z34.92  second trimester

Z34.93  third trimester