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#1 Posted : Friday, February 17, 2023 6:40:22 PM(UTC)

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Help, I had a motorcycle accident and partially knocked out a tooth on upper left side. My dentist has no idea on what codes to send to Anthem. I submitted what they processed to my dental insurer and Anthem is needing the medical code and diagnostic codes.

I need the following:

D7210 / surgical ext
D4266 / membrane (resorbable per site)
D7953 / Bone Graft for Ridge Preservaation / Sinus

D7951 / Sinus Augment w/ Bone Via Lateral

D4266 I beleive is 41870
D7953 I beleive is 21210 and possibly for D7951?

Anyway, can you assist in the cooresponding medical codes and dignostic codes.

#2 Posted : Monday, February 20, 2023 10:53:41 AM(UTC)

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Hi TommyB!

No problem!

D7953 - bone replacement graft for ridge preservation - per site
D7951 - sinus augmentation with bone or bone substitutes via a lateral open approach
for an upper tooth, can be cross coded to:
21210 - Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)
**use modifier -52 for reduced services when bone is not obtained from patient

D7210 - Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated
D4266 - guided tissue regeneration - resorbable barrier, per site

Extractions & guided tissue regeneration do not have direct crosscode - so you can either bill the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), or you can use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures

As for the diagnosis code(s), based on what you described, here are some coding options:

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

S03.2XXA - Dislocation of tooth, initial encounter

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

G89.11 - Acute pain due to trauma

You will also want to use a code to represent the motorcycle accident. The code for that will depend on the specifics of the accident - i.e. were you the driver or a passenger? Was it a traffic accident involving another vehicle, or non-collision which something else?
For example, if you were the driver, an option is:
V23.49XA - Other motorcycle driver injured in collision with car, pick-up truck or van in traffic accident, initial encounter

If this code doesn't accurately describe the situation, feel free to provide me with some additional details and I'm happy to offer you some coding options.

Hope this helps!
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