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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!
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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?
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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?
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Hi Guest!
Here are some ICD-10 diagnosis codes for the trauma and accident situation you described:
For the trauma to teeth:
S02.5XXD - Fracture of tooth (traumatic), subsequent encounter for fracture with routine healing
S02.5XXG - Fracture of tooth (traumatic), subsequent encounter for fracture with delayed healing
S02.5XXK - Fracture of tooth (traumatic), subsequent encounter for fracture with nonunion
S03.2XXD - Dislocation of tooth, subsequent encounter
M26.34 - Vertical displacement of fully erupted tooth or teeth
M26.33 - Horizontal displacement of fully erupted tooth or teeth
For the fall from balcony:
W13.0XXD - Fall from, out of or through balcony, subsequent encounter
W51.XXXD - Accidental striking against or bumped into by another person, subsequent encounter
For the tooth extractions:
Extractions do not have direct crosscodes 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 codes below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures
Hope this helps!
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Thanks . So far my insurance approved me for a dentures, im only 30. And have been depressed to the point I literally have agoraphobia. I was told i need alot of dental work.
Teeth #4,5 are broken in half with no hope of being repaird . Must be pulled
Teeth # 8,9 had severe trauma tooth 9 is fractured inside the gum line. Tooth 8 is extremely loose due to bone loss from tooth 9.
Tooth number 12 was previously extracted 8 years ago, tooth 13 is completely hollowed out from deterioration from broken tooth. Dentist recommended route canal however its not covered under benefits , which would leave no ther other alternative then to have extracted aswell
Teeth # 32 ,31 had an infection in January. They were extracted
And finally tooth number 30 has a huge fracture .
My medical insurance states since I currently have 4 top and bottom teeth that touch. They cannot approve me for implants. In your opinion after having the dental work as described that i need . Do you you think i would be eligible for implants .
Keep in mind , ive been told teeth number 8 & 9 need a bone graph
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I was out with friends. At a local restaurant/pub . There was a second floor balcony. Long story short, a drunk patron stumbled into me which ended up with me going over the balcony to the street face down. After being rushed to the hospital, medically subdued, i awoke to both front teeth damaged. They considered it trauma. Tooth #8 was fractured at the gum. And I believe #7 has become severely loose. A temporary medical splint was added until i was able to speak to an orthopedic surgeon. Now its been over a year. I still have the brace however the 2 front teeth have greatly moved from its original origins.and since the accident 3 other teeth have cracked severely. And i was told they need to be pulled .. please help!!
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Hi Guest!
No problem i'm happy to help in any way I can :)
Let's start with the diagnosis codes based on what you described. Here are some possibilities below:
First, the two you mentioned:
M25.373 stands for: Other instability, unspecified ankle
As for 717.87, i actually don't show that as a valid ICD code - did you mean to type something else?
For the damage to the teeth:
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
S03.2XXA - Dislocation of tooth, initial encounter
M26.34 - Vertical displacement of fully erupted tooth or teeth
M26.33 - Horizontal displacement of fully erupted tooth or teeth
K08.531 - Fractured dental restorative material with loss of material
K08.530 - Fractured dental restorative material without loss of material
For the fall:
W11.XXXA - Fall on and from ladder, initial encounter
W11.XXXD - Fall on and from ladder, subsequent encounter
As for the procedures:
there is actually not a direct crosscode for CPT, 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
Bone grafts:
21210 - Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)
21215 - Graft, bone; mandible (includes obtaining graft)
**use modifier -52 for reduced services when bone is not obtained from patient
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)
Of course, if there are any associated office visits those can be reported using evaluation & management (E&M) codes, and if there are any x-rays associated. For example, if a pano x-ray is formed, the CPT code is 70355.
Hope this helps!
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I am the patient and need help with getting my dental covered by my medical and there are NO dental offices in my county that know how to bill medical for anything. I fell due to having a bad ankle joint (it was very loose and weak) and I’ve had the joint surgically repaired so there is an Ortho that has diagnosed me with this issue and used codes 717.87 and M25.373 for diagnosis. When I fell I busted one tooth completely to the gum line(root left), 2 teeth pretty close to the gum line, had a crown on one of the teeth and the pieces of tooth broke other teeth when I slammed my chin. I was on a ladder and when I put my weight onto my right ankle and lifted up my left leg and fell due to the pain in my ankle weight bearing. I hit my teeth on one ladder rung and my chin on the next. I am trying to figure out what codes need to be used for extraction (normal and surgical), and for all the dental implant stuff and what diagnosis codes to use. I’m a medical assistant very familiar with billing but was never taught the dental side of medical billing. I appreciate any and all help you are able to provide and insurance is BC/BS employer provided PPO.
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Hi Guest!
No problem, based on what you described, here are some ICD-10 diagnosis coding options for you:
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
It sounds like fractures from your description, but if there were teeth lost:
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
K08.419 - Partial loss of teeth due to trauma, unspecified class
(if the class isn't documented/known, choose the unspecified class option)
As for the fall:
W10.8XXA - Fall (on) (from) other stairs and steps, initial encounter
W10.8XXD - Fall (on) (from) other stairs and steps, subsequent encounter
W10.8XXS - Fall (on) (from) other stairs and steps, sequela
As for hospital care CPT codes:
99221 - hospital care, new, level 1
99222 - hospital care, new, level 2
99223 - hospital care, new, level 3
99231 - hospital - subseq., level 1
99232 - hospital - subseq., level 2
99233 - hospital - subseq., level 3
Hope this helps!
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Hi- Im looking for a medical procedure code and diagnosis code for a 12 yo diabled boy who fell onto some poorly placed metal bleachers at an indoor sports complex and cracked 2 front teeth in half. His disability required him to have the procedure done at a children's hospital a month after the event where he was placed under general anesthesia.
Dental insurance will not pay for the hospital stay (dental proc code D9420 hosp/surg ctr calls) and it seems like something medical should pay for but they keep kicking it back to dental because of codes-- so need xref and diag code..(im thinking 99221 + K08.411 - Partial loss of teeth due to trauma, class I--???
Thanks for any help..
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