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Guest
#1 Posted : Tuesday, September 20, 2022 5:13:55 PM(UTC)
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Guest

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Hello Forum, I'm a parent of a child who's survived 3 bouts with Leukemia. He's had multiple rounds of chemo and radiation and a bone marrow transplant that led to advanced, non-restorable dental caries and failing dentition. I have a letter from an implant specialist stating he needs all on four dual arch. Specifically, "Four maxillary dental implants with immediate fixed prosthesis and four mandibular dental implants with immediate fixed prosthesis."
I'm trying to get this covered by our health insurance which normally does not cover this procedure. (BCBS Illinois, PPO) I've made significant progress and I have a letter from the periodontist stating the procedure is medically necessary. The insurance company is now asking for a diagnosis code and/or a CPT code. My question is, does anyone know what codes are applicable for this situation? Although my implant office is trying to help us, they don't know what codes to use or how to navigate health insurance vs. dental. I'm assuming I'll have to pay upfront and then try to collect reimbursement from the insurance co. if I can get them to cover the procedure. Any help or advice is deeply appreciated!
courtneydsnow
#2 Posted : Thursday, September 22, 2022 8:12:49 AM(UTC)
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courtneydsnow

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Hi Guest!

Based on what you described, here are some ICD-10 (diagnosis) coding options to offer to your implant office for the doctor to select/confirm:

K02.3 - Arrested dental caries
K02.51 - Dental caries on pit and fissure surface limited to enamel
K02.52 - Dental caries on pit and fissure surface penetrating into dentin
K02.53 - Dental caries on pit and fissure surface penetrating into pulp
K02.61 - Dental caries on smooth surface limited to enamel
K02.62 - Dental caries on smooth surface penetrating into dentin
K02.63 - Dental caries on smooth surface penetrating into pulp
K02.7 - Dental root caries
K02.9 - Dental caries, unspecified
K03.89 - Other specified diseases of hard tissues of teeth
K04.1 - Necrosis of pulp
K04.2 - Pulp degeneration
K04.01 - Reversible pulpitis
K04.02 - Irreversible pulpitis

Z92.3 - Personal history of irradiation
Z92.21 - Personal history of antineoplastic chemotherapy


Hope this helps!
Guest
#3 Posted : Friday, September 23, 2022 9:40:04 AM(UTC)
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Guest

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Yes, this helps. Thank you!
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