|
|
Hi! I hope you can help me with this.
We have a patient that lost consciousness and fell face-forward onto concrete, resulting in several fractured teeth requiring removal. The teeth have already been extracted and the patient is now ready for implants. The patient's medical insurance does have implant coverage as long as specific criteria are met, however, they also told me the exclusions for coverage included something along the lines of 'if it is due to trauma from a force outside of the mouth.' That says to me that they will not cover it for the result of a fall. The patent has spoken with the insurance company and said that since he fainted due to a medical reason/episode, they will cover it if we code it correctly.
How can I code for this? The patient is wanting between 2-5 implants, depending on their coverage.
THANK YOU for any insight you can provide!
|
|
|
Hi guest!
Absolutely!
The CPT (procedure) codes for implants are:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial (3 or less)
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more)
You'll also need ICD-10 (diagnosis) codes to describe the injury & accident. Here are some common ones for ski accidents:
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
K08.411 - Partial loss of teeth due to trauma, class I
K08.412 - Partial loss of teeth due to trauma, class II
K08.413 - Partial loss of teeth due to trauma, class III
K08.414 - Partial loss of teeth due to trauma, class IV
V00.321A - Fall from snow-skis, initial encounter
V00.321D - Fall from snow-skis, subsequent encounter
V00.322A - Snow-skier colliding with stationary object, initial encounter
V00.322D - Snow-skier colliding with stationary object, subsequent encounter
V00.328A - Other snow-ski accident, initial encounter
V00.328D - Other snow-ski accident, subsequent encounter
Hope this helps!
|
|
|
Hello!
Can you please help me with coding for a dental implant through BCBS due to a skiing accident? The grafting has already been done. Thank you!
|
|
|
Hi Christian!
No problem. Just a heads up, most medical insurers do stipulate that in order for accidental injury to teeth to be covered by medical insurance, the injury needs to be to "sound, natural teeth" - so since the damage was done to a bridge, it may not be covered.
Having said that, let's start with the ICD-10 (diagnosis) coding options:
For the fractured bridge:
K08.530 - Fractured dental restorative material without loss of material
K08.531 - Fractured dental restorative material with loss of material
If there was pain due to the trauma:
G89.11 - Acute pain due to trauma
Now, to describe the accident, they get very specific! I understand it was the driver, depending on if the collision was with another vehicle or not and what type also affects the code. For example, here are some that may fit your case:
V43.51XA - Car driver injured in collision with sport utility vehicle in traffic accident, initial encounter
V43.52XA - Car driver injured in collision with other type car in traffic accident, initial encounter
V43.53XA - Car driver injured in collision with pick-up truck in traffic accident, initial encounter
V43.54XA - Car driver injured in collision with van in traffic accident, initial encounter
If it was a collision with a stationary object, bicyclist, animal, etc - let me know and I can provide you a more specific code for the situation.
Now for the procedure (CPT) coding:
Implant bridges do not have a direct crosscode we are aware of, so you can either bill the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), or you can use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures
Hope this helps!
|
|
|
I have a patient involved in an auto accident. She was the driver of the car and was hit in the face with the air bag. Her front bridge broke and she now needs a 3 unit implant bridge. Can you help with diagnosis and procedure codes? Thanks
|
|
|
Hi Guest!
You would code the implant and the extraction separately. Here are the codes for implants:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3or less)
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more)
As for extractions, there is not currently a CPT code to represent extractions, so you can either bill the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), or you can try the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures
*use the 51 modifier to indicate multiple procedures performed on the same day, appended to the lesser of the services.
As for diagnosis code(s) - this will depend on the patient's condition, or basically why are the services being done. If you could provide me some details on that, i would be happy to offer you some coding options.
Hope this helps!
|
|
|
how do you code immediate- implant is placed at the same time as the natural tooth is extracted.
and ICD-10 for this
|
|
|
Hi Guest!
Here are the CPT codes for implants:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3 or less)
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more)
As for the diagnosis code(s), here are some options based on what you described:
K00.0 - Anodontia
K00.4 - Disturbances in tooth formation
K00.6 - Disturbances in tooth eruption
K00.8 - Other disorders of tooth development
K08.89 - Other specified disorders of teeth and supporting structures
Hope this helps!
|
|
|
I have a patient that never had #20 and #29 develop. She is 30 years old and is need of implants so that her teeth don't shift. She has an ortho retainer that she uses. What diagnosis codes and medical codes are needed to find out if her medical insurance will cover the implants?
|
|
|
Hi Guest!
I'm sorry you're going through that. It sounds like your medical insurer told you that they are looking for coverage criteria that there are less that four teeth top/bottom that touch each other in order to qualify for coverage of implants, am I understanding correctly?
|