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

New Topic Post Reply
Guest
#1 Posted : Wednesday, December 5, 2018 1:50:32 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 978

Was thanked: 16 time(s) in 15 post(s)
Hello . We billed to medicare for 21248 and 21215 (52). For 21248 we used K08.423. For 21215 we used K08.22. Claim was denied because they considered these ICD codes routine .
what was wrong?

Thank You
courtneydsnow
#2 Posted : Wednesday, December 5, 2018 6:06:07 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,213

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

Great question:

K08.423 stands for:
Partial loss of teeth due to periodontal diseases, class III

K08.22 stands for:
Moderate atrophy of the mandible

For bone grafts and implants, simply loss of teeth due to perio disease and moderate atrophy alone won't always do the trick to establish medical necessity. For example - is the patient experiencing pain or problems with mastication? If there is not something additional like that present, then many medical insurers would deem these procedures cosmetic, or dental in nature. Or for example, many trauma cases would see coverage as medically necessary.

Hope this helps!
Guest
#3 Posted : Thursday, December 27, 2018 5:24:30 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 978

Was thanked: 16 time(s) in 15 post(s)
THANK YOU . So , what icd10 codes can we use that get paid..Patient cannot stand any removable prosthesis. And she needed bone graft for sure before implants .
What codes Medicare would consider as medical necessity?
Thank You
/
Guest
#4 Posted : Thursday, December 27, 2018 5:25:59 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 978

Was thanked: 16 time(s) in 15 post(s)
THANK YOU . So , what icd10 codes can we use that get paid..Patient cannot stand any removable prosthesis. And she needed bone graft for sure before implants .
What codes Medicare would consider as medical necessity?
Thank You
/
courtneydsnow
#5 Posted : Friday, December 28, 2018 3:10:08 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,213

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

Great question. The diagnoses that establish medical necessity for bone grafts and implants do vary from insurer to insurer. However, some diagnoses/situations where we typically see coverage are items like:

- Trauma/accidents - of course there are many different diagnostic codes available to represent different traumas and injuries, but a few common ones:

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
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture

- Tumors/cysts/abscess - again there are many, but here are a few examples:
K12.2 - Cellulitis and abscess of mouth
K04.6 - Periapical abscess with sinus
K04.7 - Periapical abscess without sinus
K09.0 - Developmental odontogenic cysts
K09.1 - Developmental (nonodontogenic) cysts of oral region
K09.8 - Other cysts of oral region, not elsewhere classified
K04.8 - Radicular cyst
C03.0 - Malignant neoplasm of upper gum
C03.1 - Malignant neoplasm of lower gum
C03.9 - Malignant neoplasm of gum, unspecified
C04.0 - Malignant neoplasm of anterior floor of mouth
C04.1 - Malignant neoplasm of lateral floor of mouth
C04.8 - Malignant neoplasm of overlapping sites of floor of mouth
C04.9 - Malignant neoplasm of floor of mouth, unspecified
C05.0 - Malignant neoplasm of hard palate
C05.1 - Malignant neoplasm of soft palate
C05.8 - Malignant neoplasm of overlapping sites of palate
C05.9 - Malignant neoplasm of palate, unspecified
C06.1 - Malignant neoplasm of vestibule of mouth


For Medicare specifically - their stance on dental services is that "Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw." - here is a link to their statement:

https://www.cms.gov/Medicare/Coverage/MedicareDentalCoverage/index.html

Hope this helps!
Quick Reply Show Quick Reply
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.