Nierman Practice Management Logo
Follow us on Facebook
Follow us on Twitter
Connect with us on Linked In
View demos and More on You Tube
DentalWriter Software Logo 1-800-879-6468
Login   Register Here

Notification

Icon
Error

2 Pages<12
New Topic Post Reply
courtneydsnow
#21 Posted : Friday, March 10, 2017 9:02:14 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,205

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Guest!

Yes we do not recommend using 21110 or 21089 for appliances used to treat TMD, as these codes do fall into the surgical category of CPT coding.

21110 stands for: Application of interdental fixation device for conditions other than fracture or dislocation, include removal

21089 stands for: Unlisted maxillofacial prosthetic procedure

Although we have had several report of insurers telling practices to use one of the codes listed above as what happened in your case. The request for additional documentation you listed in your post does seem to be geared toward a surgical service. If 21089 is in fact the code that your insurer requires an office to bill for a TMD appliance, the office should be able to send along their clinical documentation which will describe the exact procedures/services rendered.

What we are finding is that the code that is most commonly accepted by medical insurers currently for TMD appliances since the S8262 discontinuation June 2015 is D7880. However, some insurers are accepting the other codes listed below as well:

D7880 - occlusal orthotic device, by report

D7899 - unspecified TMD therapy, by report

Or, if the medical insurer says they won’t process the “D” codes (most will these days, but you will run into a few that won’t), you can try:

E1399 - Durable medical equipment, miscellaneous
21299 - Unlisted craniofacial and maxillofacial procedure
21499 - Unlisted musculoskeletal procedure, head

A narrative report explaining the treatment accompanying the claim is recommended since they are all "by report", “unlisted”, or "miscellaneous" codes.

For example, Aetna's medical policy for Temporomandibular disorders lists D7880 as an accepted HCPCS code is criteria is met: http://www.aetna.com/cpb/medical/data/1_99/0028.html

If you would like to tell me the name of your insurance company, I would be happy to locate the medical policy online if it is available and see if there is a specific code listed in their policy like Aetna's.

Hope this helps!
Guest
#22 Posted : Friday, March 10, 2017 1:07:26 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 965

Was thanked: 16 time(s) in 15 post(s)
We are having problems with Anthem Blue Cross of California paying for the repositioning device. We have been using 21299 which is an unlisted surgical code. Should this code not be used? Based on other posts the recommended code is D7880, correct?
mbrzezinski
#23 Posted : Monday, March 13, 2017 10:50:37 AM(UTC)
Quote
mbrzezinski

Rank: Advanced Member

Joined: 7/22/2014(UTC)
Posts: 101

Was thanked: 1 time(s) in 1 post(s)
Hi Guest!

What we are finding is that the code that is most commonly accepted by medical insurers currently for TMD appliances since the S8262 discontinuation June 2015 is D7880. However, some insurers are accepting the other codes listed below as well:

D7880 - occlusal orthotic device, by report

D7899 - unspecified TMD therapy, by report

Or, if the medical insurer says they won’t process the “D” codes (most will these days, but you will run into a few that won’t), you can try:

E1399 - Durable medical equipment, miscellaneous
21299 - Unlisted craniofacial and maxillofacial procedure
21499 - Unlisted musculoskeletal procedure, head

A narrative report explaining the treatment accompanying the claim is recommended since they are all "by report", “unlisted”, or "miscellaneous" codes.

For example, Anthem of CA's medical policy for Temporomandibular disorders lists D7880 as an accepted HCPCS code is criteria is met:
https://www11.anthem.com...elines/gl_pw_a051149.htm

Hope this help!
Guest
#24 Posted : Monday, March 13, 2017 1:21:36 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 965

Was thanked: 16 time(s) in 15 post(s)
I have Cigna insurance. Finally had an agent willing to help & he said. The reason my claims are rejected was b/c the 21499 wasn't specific enough. We need a code after the 21499 and must ask for that code in writing. He actually showed me where to find the request form and said it must be notarized. I have a temporary orthotic and the charge was $5,000 last April. Do you know the code they want? I'm worried that my request will just be lost or will be delayed in some other way. Thank you!
Guest
#25 Posted : Monday, March 13, 2017 1:43:50 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 965

Was thanked: 16 time(s) in 15 post(s)
In addition to the above question: The final phase of treatment is as described by doctor, "permanently set jaw/teeth to the corrected bite by crowning all of the teeth. This will allow some teeth to be built up to the corrected bite and will in turn set the whole jaw to its corrected alignment." Do you know what codes Cigna will require for this final phase? I'm about 6 months past where I should be due to the hold up with insurance. I'm in pain and cannot sleep. Thank you for your help!!
courtneydsnow
#26 Posted : Thursday, March 16, 2017 9:37:00 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,205

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi guest!

Here is a link to Cigna's medical policy titled "Temporomandibular Joint
(TMJ) Disorder Surgery":
https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0156_coveragepositioncriteria_tmj_disorder_surgery.pdf

Although the policy indicates "surgery" in the title, the policy does contain this reference for "reversible intra-oral appliances":

Treatment
Noninvasive, reversible therapies are used in the initial treatment of symptomatic TMD. In many cases, TMD is self-limiting and often responds to simple measures such as eating soft foods, applying heat or ice, and avoiding extreme jaw movements (e.g., wide yawning, gum chewing). Other conservative treatments include:
•Pharmacological pain control: Nonsteroidal anti-inflammatory drugs (NSAIDs), opiates, muscle relaxants and low-dose antidepressants may be useful for symptom management.
•Physical therapy: A variety of modalities may be employed, including active or passive jaw movement, application of heat/ice and vapocoolant spray followed by gentle stretching.
•Intra-oral appliances: The two most common intra-oral appliances are stabilization splints and anterior positioning appliances. Stabilization splints may be used to provide joint stabilization, reduction of pressure within the joint and relaxation of elevator muscles. These appliances should not create major alteration in occlusion, since these changes may be irreversible and lead to other problems. Anterior positioning appliances, also called orthopedic repositioning appliances, are used for acute joint pain, painful crepitus and symptomsassociated with acute limitation of motion caused by an anterior displaced disc without reduction (closed lock).

Trigger-point injections may be used when the above noninvasive treatments do not provide adequate symptom relief, or may be used as part of a physical therapy program.


Unfortunately, it does not appear that Cigna provides any coverage criteria for reversible intra-oral appliances in their policy, and does not appear to have a policy available on their website for conservative methods of TMD treatment either. All of the procedure codes listed in this policy are surgical. It is possible that Cigna is deeming your treatment "dentally related" or not medically necessary. They also have language in the policy that states:

Treatment of temporomandibular joint (TMJ) disorder is specifically excluded under some benefit plans, and coverage may be governed by state mandates. Please refer to the applicable benefit plan document to determine benefit availability and the terms and conditions of coverage.
Many medical plans do not cover orthodontic treatment provided as an adjunct to temporomandibular
joint (TMJ) disorder surgery, because such treatment is considered dental in nature and, therefore, not covered under the medical benefit.


It may be worth a shot to ask Cigna if your benefit plan excludes conservative treatment of TMD, and even see if they can provide you with a copy of their coverage criteria for reversible intra-oral appliances.

Hope this helps, have a great day!
Guest
#27 Posted : Wednesday, July 12, 2017 3:27:42 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 965

Was thanked: 16 time(s) in 15 post(s)
We recently got contracted with Medicare and are trying to bill medical insurance for procedures covered by medical insurance. My question is can a General Dentist bill Medicare for an TMD device and would the 21110 be a code to use?
courtneydsnow
#28 Posted : Wednesday, July 12, 2017 3:55:24 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,205

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Guest!

Great question. To our knowledge, Medicare does not offer coverage for oral appliance used to treat TMD.

21110 is not an appropriate code for TMD appliances, as the description for 21110 is: Application of interdental fixation device for conditions other than fracture or dislocation, include removal

Medicare states in their LCD for oral appliances for OSA, that appliance used to treat TMD should be coded D7880.

Hope this helps!
Guest
#29 Posted : Friday, March 9, 2018 4:11:24 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 965

Was thanked: 16 time(s) in 15 post(s)
We are trying to bill to BCBS MA Medical HMO Blue for an NTI device. The NTI website, seminar documents and paperwork recommends that the CPT code to use is 21110-52. I am reading through this thread and it appears that Dentists are not having luck with that code. I have not yet asked the Insurance provider support line if that code is payable. When I initially contacted the insurer they asked if this was MORA and told me the benefits for a MORA appliance. I'm hearing that an NTI device is not exactly a MORA which as a front desk Insurance coordinator, I honestly don't understand this and the Dentist doesn't get involved with splitting hairs with coding. Pretty much for Sleep Apnea and NTI devices since our general dentist not on the special provider list he is not considered an In Network BCBS provider so he is not going to get paid unless we get a network exception form filled out by the Patient's PCP. The PCP has agreed to write the exception letter for us but needs to have the code before writing the exception letter. I therefore do not want to have that PCP exception letter have a non payable code on it. I would greatly appreciate some guidance as to whether BCBS MA HMOBLUE MEdical will accept the 21110-52 code or if we should use a CDT Code either D9940 or D7880 to bill to Medical. Thank you so much for your time.
courtneydsnow
#30 Posted : Monday, March 12, 2018 9:38:24 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,205

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Guest!

Great question. Unfortunately, there is not 1 straightforward answer at this time for the question "What code is best to use for an oral appliance being used to treat temporomandibular disorder (TMD/TMJD)?"

Ever since the S8262 discontinuation June 2015 (which was a code used for several years to represent TMD appliances), what we have found is that the code that is most commonly accepted by medical insurers for TMD appliances is D7880. However, some insurers are accepting the other codes listed below as well:

D7899 - unspecified TMD therapy, by report
21299 - Unlisted craniofacial and maxillofacial procedure
E1399 - Durable medical equipment, miscellaneous

A narrative report explaining the treatment accompanying the claim is recommended since they are all "by report", “unlisted”, or "miscellaneous" codes.

Note: we do tend to find BCBS many times does not want to process the "D" codes as another insurers do....

Hope this helps, have a great day!
Guest
#31 Posted : Monday, March 12, 2018 10:16:11 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 965

Was thanked: 16 time(s) in 15 post(s)
I am attempting to submit to HealthPartners and they state I need to include diagnosis code.....would that be M26.60 and can I submit that w/D7880. Ran in to the same thing with Medica.....needing diagnosis code??? Any help would be amazing!!

Thank you!
courtneydsnow
#32 Posted : Monday, March 12, 2018 10:21:46 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,205

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Guest!

Yes every medical claim requires at least 1 diagnosis code, and up to 12 can be listed.

M26.60 is no longer a "billable" diagnosis code, because there are more specific diagnosis codes available now to describe temporomandibular disorders (TMD). There are of course other diagnostic codes that may be used as well to describe symptoms/pain associated with the TMD. Below are the TMD diagnosis coding options:

M26.601 Right temporomandibular joint disorder, unspecified
M26.602 Left temporomandibular joint disorder, unspecified
M26.603 Bilateral temporomandibular joint disorder, unspecified
M26.609 Unspecified temporomandibular joint disorder, unspecified side
M26.611 Adhesions and ankylosis of right temporomandibular joint
M26.612 Adhesions and ankylosis of left temporomandibular joint
M26.613 Adhesions and ankylosis of bilateral temporomandibular joint
M26.619 Adhesions and ankylosis of temporomandibular joint, unspecified side
M26.621 Arthralgia of right temporomandibular joint
M26.622 Arthralgia of left temporomandibular joint
M26.623 Arthralgia of bilateral temporomandibular joint
M26.629 Arthralgia of temporomandibular joint, unspecified side
M26.631 Articular disc disorder of right temporomandibular joint
M26.632 Articular disc disorder of left temporomandibular joint
M26.633 Articular disc disorder of bilateral temporomandibular joint
M26.639 Articular disc disorder of temporomandibular joint, unspecified side
M26.69 Other specified disorders of temporomandibular joint

Hope this helps!


Guest
#33 Posted : Tuesday, March 13, 2018 9:25:48 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 965

Was thanked: 16 time(s) in 15 post(s)
Hello! I have been looking through the replies on this thread and we are also having trouble with Humana medical and getting TMJ splints authorized. They are advising us to use code 21089 but I have read in this thread that that code is not appropriate. We have used 21085 in the past but Humana is giving us a hard time with this code.

I am concerned with using unlisted codes because we have no idea what reimbursement will be. Are there any options outside of unlisted codes?
courtneydsnow
#34 Posted : Tuesday, March 13, 2018 10:58:42 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,205

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Guest!

Great question. While 21089 is not necessarily one of codes we suggest (based on the description of it and other codes that are available and being accepted by some medical insurers) - if the medical insurer instructs you to use it - that may be your best option!

The description of 21089 is: Unlisted maxillofacial prosthetic procedure

However - no there are no other codes we are aware of currently that are specific codes that are being used to represent appliances being used to treat TMD - they are all "unlisted" or "misc" codes:

Ever since the S8262 discontinuation June 2015 (which was a code used for several years to represent TMD appliances), what we have found is that the code that is most commonly accepted by medical insurers for TMD appliances is D7880. However, some insurers are accepting the other codes listed below as well:

D7899 - unspecified TMD therapy, by report
21299 - Unlisted craniofacial and maxillofacial procedure
E1399 - Durable medical equipment, miscellaneous

A narrative report explaining the treatment accompanying the claim is recommended since they are all "by report", “unlisted”, or "miscellaneous" codes.

But, as you mentioned, the allowed amount can vary significantly with these codes as they are unspecific codes.

Hope this helps!

Guest
#35 Posted : Wednesday, March 14, 2018 9:30:16 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 965

Was thanked: 16 time(s) in 15 post(s)
I'm the BCBSMA question above. Thank you so much for your prompt answers. I called BCBSMA and asked if any of the following codes were payable under their contract and the answer was NO
D7880
D7899
21299
21110-52

I'm not going to use the DME code, the E1399 because they already told me it is not under the DME policy, it is under TMJ treatment which is payable with just a copay of $40 but noone can tell me what code is payable. Its like playing Chutes and Ladders but its not feeling like a fun game.

EDIT: Just on the phone with BCBSMA for an hour and the rep did an exhaustive look into policy and codes and told me it is a complete discrepancy that he doesn't know what code to be used and that I need to do more research and try calling the clinical line, so I will update this as I hear more but I would also love to hear back from anyone else that has had success with BCBSMA Medical

Edited by user Wednesday, March 14, 2018 10:27:08 AM(UTC)  | Reason: Not specified

 1 user thanked Guest for this useful post.
courtneydsnow on 3/16/2018(UTC)
courtneydsnow
#36 Posted : Friday, March 16, 2018 8:43:41 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,205

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Guest!

Wow yes they are certainly putting you through the ringer on what code to use! When their own rep can't figure it out - it is no wonder the entire industry is not clear on it either!

The only other code I have seen reported as successful (that i am even decently comfortable with the description on) that you didn't mention above is 21499.

Thanks for the updated info, and would love to hear how this one turns out!
Quick Reply Show Quick Reply
2 Pages<12
New Topic Post Reply
Forum Jump  
You can post new topics in this forum.
You can reply to topics in this forum.
You can delete your posts in this forum.
You can edit your posts in this forum.
You cannot create polls in this forum.
You can vote in polls in this forum.