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Guest
#1 Posted : Friday, April 21, 2017 11:17:44 AM(UTC)
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Hi, patient got bone grafting procedure (D7953) to get dental implant placement however his dental insurance denied saying that this procedure is a medical benefit. So, I submit the claim to his Medical Insurance.Now medical insurance is asking the diagnosis code for this treatment. There is no accident or trauma. What could be the diagnosis code for medical?

P.S.: Treating dentist is an oral surgeon

Thanks
Gina
courtneydsnow
#2 Posted : Monday, April 24, 2017 8:28:46 AM(UTC)
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courtneydsnow

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Hi Gina!

Great question. The diagnosis code will depend on why the bone graft and implant are needed. Many times the diagnosis code for bone graft is atrophy, but also may be something else depending on what the patient's condition is.

For example, here are the atrophy codes below:

K08.21 - Minimal atrophy of the mandible
K08.22 - Moderate atrophy of the mandible
K08.23 - Severe atrophy of the mandible
K08.24 - Minimal atrophy of maxilla
K08.25 - Moderate atrophy of the maxilla
K08.26 - Severe atrophy of the maxilla

If the bone graft and implant are being done for a different reason, let me know and I'd be happy to offer you some coding options.
Guest
#3 Posted : Tuesday, April 9, 2019 2:57:45 PM(UTC)
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Hi, I am a patient that had an implant procedure approx. 5 years ago. However in October 2018 with xray It was found that the bone around the implant deteriorating thus I needed to have this re done. As a result my dental insurance see the new bone grafting as a medical procedure but the dentist that completed the procedure does not know what diagnosis code to use can you help us. The procedure code he used was D7953
Thank you, Leslie
courtneydsnow
#4 Posted : Wednesday, April 10, 2019 10:25:49 AM(UTC)
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Hi Leslie!

Based on what you described, here are some possible diagnosis coding options:

K08.21 - Minimal atrophy of the mandible
K08.22 - Moderate atrophy of the mandible
K08.23 - Severe atrophy of the mandible
K08.24 - Minimal atrophy of maxilla
K08.25 - Moderate atrophy of the maxilla
K08.26 - Severe atrophy of the maxilla
M27.61 - Osseointegration failure of dental implant
M27.62 - Post-osseointegration biological failure of dental implant
M27.63 - Post-osseointegration mechanical failure of dental implant
M27.69 - Other endosseous dental implant failure


Also, for the procedure coding:
D7953 - bone replacement graft for ridge preservation - per site
Can be cross coded to:
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

Hope this helps!
Guest
#5 Posted : Tuesday, October 15, 2019 2:23:01 PM(UTC)
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As a periodontist, I am interested if my patients can receive medical benefits for these items:

Cone Beam CT scans: Dental Code D0380, D0382, D0383
Intra Oral Scans: 3D Photo Image: D0351
Night Guard: Hard D9944, Soft D9945
Resorbable Membrane: D4266
Bone Graft (Guided Bone Regeneration): D7950
Open Flap Surgery: D4240 or D4241

What choices of Medical Diagnosis codes, etc could be helpful for billing?

Thank you!

Edited by user Tuesday, October 15, 2019 2:24:56 PM(UTC)  | Reason: Clarification

courtneydsnow
#6 Posted : Friday, October 18, 2019 11:40:36 AM(UTC)
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Hi Guest!

Great question. Whether or not the patient will be eligible for medical coverage/reimbursement for the services you listed will all depend on the "why" basically! Your patient's condition/diagnosis will determine if the medical insurer considers those services medically necessary or not. For example, it is not typical for a medical insurer to offer coverage for a single implant, however if it is needed due to a traumatic accident or tumor removal, it can be covered! Same with the services you listed - it's not extremely common for a medical insurer to cover just a plain night guard/occlusal guard, however if the patient is diagnosed with TMJD and the appliance is being used to treatment, many medical insurers offer coverage for that. Or, if it is an appliance being used to treat Obstructive Sleep Apnea, most medical insurers do offer coverage.

We have wonderful crosscoding seminars that we hold around the country to teach dental practices to effectively work with medical insurance for various treatments and procedures such as sleep apnea appliances, treatment for TMJD, office visits, x-rays, frenectomies, etc. Here is link to our seminar schedule, we would love to have you join us at one: https://niermanpm.com/dental-continuing-education/schedule

Hope this helps!
Guest
#7 Posted : Monday, November 4, 2019 10:25:58 AM(UTC)
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Hi, I am a patient of a dentist. I was seen for the extraction of three upper molars. Pathology resulted in the erosion and perforation of the sinus floor bilaterally resulting in extensive mucositis/sinusitis/infection. Removal of the infected teeth resulted in sinus perforation on both sides. To avoid a prolonged infection and more rapid healing the dentist performed a socket graft/oral-astral closure.
The procedure was coded to D7921 collection and application of blood and to D7953 bone replacement graft for the dentist's billing purposes. These codes are not a benefit for my dental insurance and do not work medical billing. I have submitted a claim to Medicare and they are asking for ICD.9 or ICD.10 diagnosis codes.
Do you have any suggestions for a code for medical insurance reimbursement purposes?

Thank you for any suggestions you have

Joe
courtneydsnow
#8 Posted : Monday, November 11, 2019 1:21:19 PM(UTC)
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Hi Joe!

Based on what you described below, here are some ICD-10 coding options for the condition:

J34.89 - Other specified disorders of nose and nasal sinuses
J34.81 - Nasal mucositis (ulcerative)
K12.39 - Other oral mucositis (ulcerative)

J01.00 - Acute maxillary sinusitis, unspecified
J01.01 - Acute recurrent maxillary sinusitis
J01.10 - Acute frontal sinusitis, unspecified
J01.11 - Acute recurrent frontal sinusitis
J01.20 - Acute ethmoidal sinusitis, unspecified
J01.21 - Acute recurrent ethmoidal sinusitis
J01.30 - Acute sphenoidal sinusitis, unspecified
J01.31 - Acute recurrent sphenoidal sinusitis


J32.0 - Chronic maxillary sinusitis
J32.1 - Chronic frontal sinusitis
J32.2 - Chronic ethmoidal sinusitis
J32.3 - Chronic sphenoidal sinusitis
J32.4 - Chronic pansinusitis
J32.8 - Other chronic sinusitis
J32.9 - Chronic sinusitis, unspecified


Hope this helps!
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