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D7880 vs D9940 for dental insurance
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Frustrated
#21 Posted : Thursday, June 9, 2016 1:07:24 PM(UTC)
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I am billing for TMD to ChampVA and they are telling me they will no longer accept dental codes but only CPT medical codes. They specifically are saying I must use medicare codes and that codes changed Oct. 1, 2015 effective Jan. 1, 2016 but for the life of me I cannot find the proper CPT code. I am billing for Occlusal Orthotic (D7880). Can you help me with this?

Thanks for your time,
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courtneydsnow
#22 Posted : Monday, June 13, 2016 11:06:18 AM(UTC)
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Hi frustrated!

Great question - what we are finding is that the code that is most commonly accepted by medical insurers currently for TMD appliances since the S8262 discontinuation last June 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.

It may be best to look up the insurers medical policy for Temporomandibular disorders and check the coding section of the policy to see if a specific code they accept is listed. 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

Hope this helps, have a great day!
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Guest
#23 Posted : Monday, May 8, 2017 10:06:07 AM(UTC)
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What is the 2017 dental code for a night guard or occlusal guard
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courtneydsnow
#24 Posted : Tuesday, May 9, 2017 8:38:44 AM(UTC)
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Hi Guest!

D7880 stands for: occlusal orthotic device, by report

Hope this helps!
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MedCenter TMJ
#25 Posted : Tuesday, May 9, 2017 12:17:44 PM(UTC)
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I just received a letter from Blue Cross Blue Shield of TX stating that D7880 is no longer valid -- is this true or are they just being difficult?

Thank you!
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courtneydsnow
#26 Posted : Wednesday, May 10, 2017 8:13:19 AM(UTC)
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Hi MedCenter TMJ!

D7880 is still a valid code to our knowledge, although we do get reports from clients that some medical insurers will not process that code for TMD appliances, although it is the most commonly accepted code by most medical insurers currently.

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

Here is a link to BCBS of TX medical policy for temporomandibular disorders: http://www.medicalpolicy.hcsc.net/medicalpolicy/activePolicyPage?lid=ipchkcvu&corpEntCd=TX1

When D7880 is not accepted, we have had client report success with the following codes:

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.

Hope this helps!
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Guest
#27 Posted : Tuesday, May 30, 2017 1:26:45 PM(UTC)
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The DDS that I work for wants to start doing snore guards in our office. I'm unsure how to bill medical for these. Can I bill dental? If so, what is the appropriate code to use when billing dental?

Thanks in advance!!
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mbrzezinski
#28 Posted : Wednesday, May 31, 2017 8:18:18 AM(UTC)
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Hi Guest!

The code for a custom made oral appliance for snoring and/or sleep apnea would be:

E0486 - Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment

If the device is not custom made but pre-fabricated, the code is:
E0485 - Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment

The ICD-10 diagnosis code for snoring is:
R06.83

However, just a heads up, most medical insurers do not offer coverage for oral appliances to treat snoring alone, as they consider it "not medically necessary". However, most insurer will cover them with a diagnosis of Obstructive Sleep Apnea (OSA).

Hope this helps!
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Guest
#29 Posted : Wednesday, June 12, 2019 10:22:56 AM(UTC)
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Hi there,

I am a patient writing with a question about proper billing for a small appliance called an "Aqualizer" that was given to me by an oral surgeon to treat temporary bruxism caused by soft tissue trauma from a bicycle accident. Specifically, I'm wondering which billing code is appropriate for this appliance - I would like to ensure I'm being charged properly and also that I can submit the claim to my insurance (Dental and likely medical if Delta will not cover it) with the correct billing code.

The Aqualizer appliance (http://aqualizer.com/products/the-aqualizer/) is a temporary treatment and diagnostic tool that required no fitting or mold to produce. It was provided to me in a single office visit and I was told to use it only as a temporary device to provide relief from grinding and clenching as a result of the fall from the bicycle.

My question is whether this type of device should be billed under code D7880 or D9945 given that it is prescribed for bruxism and it a soft, temporary appliance. I don't believe it is a full arch appliance, since contact is only made at the rear teeth. However, I believe code D7880 is supposed to be used for devices treating TMD rather than bruxism and that it is typically used for appliances that require custom fitting and multiple visits.

Can someone advise whether an "Aqualizer" appliance should be billed as D7880, D9945, or some other billing code?

Thanks very much,
-Spencer
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courtneydsnow
#30 Posted : Wednesday, June 12, 2019 11:21:18 AM(UTC)
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Hi Spencer!

Great question. Since it is not a full arch appliance, D9945 is likely not an appropriate code to use. There is a code for partial arch appliance:

D9946 - occlusal guard – hard appliance, partial arch

However, as you can see, the description on this code specifies "hard appliance", and there does not yet appear to be a comparable code with this description for "soft appliance partial arch". Looking at the Aqualizer information you sent - it may be a soft appliance, but it does look like they have different construction options available so use you judgement there :)

Having said that - D7880 is likely your best option if it is a soft appliance, as the description of D7880 is:
Occlusal orthotic device, by report

Since the description includes "by report" - the appliance and treatment can be explained in a narrative report submitted with the claim. As you mentioned, this code is also commonly used by some medical insurers for appliances being used to treat TMD as well, but the "by report" in the code description allows us to provide the explanation of what it is.

Hope this helps!
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Spencer
#31 Posted : Wednesday, June 12, 2019 11:43:04 AM(UTC)
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