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stratforddental
#1 Posted : Wednesday, March 12, 2014 2:53:04 PM(UTC)
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stratforddental

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I would like help with the cross coding: D6104, D7952, D7953

I have looked at the case studies for all of these codes and the same code seems to be used for all of them...21210 and 21215. Can this be correct?
courtneydsnow
#2 Posted : Tuesday, March 18, 2014 8:00:40 AM(UTC)
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courtneydsnow

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Hi stratforddental!

Great question!

D6104 = Bone Graft at Time of Implant Placement

D7952 = Sinus Augmentation Via a Vertical Approach

D7953 = Bone Replacement Graft for Ridge Preservation

and:

21210 = Graft, bone; nasal, maxillary or malar areas (includes obtaining graft) “sinus lift”

21215 = Graft, bone; mandible (includes obtaining graft)

So - some insurers will prefer you use the CPT codes for the bone graft at time of implant placement and the sinus augmentation, but you will also find insurers that will prefer you use the "D" codes listed above on the medical claim form when billing for these procedures! Also, some insurers may consider these procedures "Dental in Nature Oral Surgery" services, depending on their medical policies guidelines.

Hope this helps, please feel free to contact us with further questions!


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stratforddental on 3/20/2014(UTC)
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#3 Posted : Friday, April 18, 2014 5:21:32 PM(UTC)
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#4 Posted : Friday, April 18, 2014 7:21:33 PM(UTC)
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Guest
#5 Posted : Tuesday, September 23, 2014 6:44:34 PM(UTC)
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Hello, I have a question regarding coding for medical claims. I have a patient that had surgical extractions with bone grafting, sinus lift with implant placement under IV sedation. Which codes would I use for billing on a CMS 1500 claim form? I did some research and it looks like bone grafting would be 21215, Sinus lift is D7951 or D7952 and implant placement is D6010, but done at same time of Implant Placement it is D6104. Also, 21210 graft bone; nasal max (including obtaining graft) "Sinus lift" can be used. Can you please advise?
courtneydsnow
#6 Posted : Wednesday, September 24, 2014 10:49:32 AM(UTC)
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courtneydsnow

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Hi Guest!

yes, you got it!

21210 = Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)
21215 = Graft, bone; mandible (includes obtaining graft)

***use modifier -52 for reduced services if bone is not obtained from the patient

Many insurers will accept the appropriate "D" code for services that don't have a specific medical code, and some will prefer you use an unspecific or miscellaneous code (i.e. 41899 or 21299) and provide a narrative report for details. I usually like to check the insurers medical policy online for clarification! - many times, the accepted and not accepted ICD, CPT & HCPCS codes will be listed right in the policy!

Hope this helps, please feel free to contact us with any further questions!

Edited by user Wednesday, September 11, 2019 7:54:59 AM(UTC)  | Reason: Not specified

Mahtab Partovi
#7 Posted : Friday, April 3, 2015 4:36:21 AM(UTC)
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Mahtab Partovi

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If you have a damaged teeth or a misaligned teeth, then getting dental implants surgery performed is the best available option for you. Although, you must consult your dentist first before going for any dental implants surgery. Orthodontist Los Angeles provides latest technological dental procedures for your healthy teeth and gums.
denver smith
#8 Posted : Wednesday, April 22, 2015 2:45:14 AM(UTC)
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denver smith

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hi all, i have a question regarding Dental Implants. I am missing all of my teeth and am now wearing a full upper and lower denture. I can no longer tolerate my lowers. Will I need an Implant for every tooth I am replacing on the lower jaw?

Edited by user Wednesday, April 22, 2015 10:25:13 PM(UTC)  | Reason: Not specified

Rose
#9 Posted : Wednesday, April 22, 2015 8:50:11 AM(UTC)
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Rose

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Originally Posted by: denver smith Go to Quoted Post
hi all, i have a question regarding dental implants. I am missing all of my teeth and am now wearing a full upper and lower denture. I can no longer tolerate my lowers. Will I need an Implant for every tooth I am replacing on the lower jaw?


Great question about implants for dentures. Once you have a consultation with your dentist, the dentist will evaluate the lower jaw bone to determine the number of dental implants needed to support your denture. A dental implant is not required for each tooth you are replacing on your lower jaw. As a matter of fact, as few as two to four dental implants can make a big difference in securing a denture.
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courtneydsnow on 4/22/2015(UTC)
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#10 Posted : Thursday, June 30, 2016 1:27:51 AM(UTC)
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Would like to know cpt code for D9243 please and thank you ?
courtneydsnow
#11 Posted : Thursday, June 30, 2016 7:21:38 AM(UTC)
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courtneydsnow

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Hi guest!

D9243 - Intravenous moderate (conscious) sedation/analgesia – each 15 minute increment

Here are some coding options for the above:
00170 - Anesthesia for intraoral procedures, including biopsy; not otherwise specified
00172 - Anesthesia for intraoral procedures, including biopsy; repair of cleft palate
00174 - Anesthesia for intraoral procedures, including biopsy; excision of retropharyngeal tumor
00176 - Anesthesia for intraoral procedures, including biopsy; radical surgery
01999 - Unlisted anesthesia procedure(s)

• 99143 - Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; younger than 5 years of age, first 30 minutes intra-service time

• 99144 - Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time

• 99145 - Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; each additional 15 minutes intra-service time (List separately in addition to code for primary service)

• 99148 - Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; younger than 5 years of age, first 30 minutes intra-service time

• 99149 - Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; age 5 years or older, first 30 minutes intra-service time

• 99150 - Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intra-service time (List separately in addition to code for primary service)
Guest
#12 Posted : Tuesday, January 17, 2017 3:14:11 PM(UTC)
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I have a treatment plan from my periodontist to pull 4 teeth and apply bone grafts to three of them; and 6 months from now will return for dental implants. For the three teeth requiring a bone graft, they are using Codes D7210 (Extraction-surgical/erupt tooth), D7953 (Bone Replacement w/ext) and D4266 (Guided tissue regen-resorb-per). In calling my insurance carrier, and searching their site by code, it appears that the Code D7953 no longer exists. Can you tell me what procedure code should be used for Bone Replacement w/ext - are they cross-coding or coding incorrectly for what I described?

Thank you.
courtneydsnow
#13 Posted : Wednesday, January 18, 2017 10:05:54 AM(UTC)
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courtneydsnow

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Hi Guest!

Great question - yes the insurer may very well be looking for the crosscode. Quick question - was it your medical insurer or your dental insurer that you were looking at?
Lee M
#14 Posted : Wednesday, February 15, 2017 4:46:41 PM(UTC)
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what is the ICD 10 codes/codes for 7951 and 4266 ?>?

thank you
courtneydsnow
#15 Posted : Thursday, February 16, 2017 9:59:40 AM(UTC)
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courtneydsnow

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Hi Lee M!

D7951 - sinus augmentation with bone or bone substitutes via a lateral open approach
D4266 - guided tissue regeneration - resorbable barrier, per site

The ICD-10 diagnosis code(s) for these services will depend on the patient's condition and why the services were done.

For example, if the services are being done due to atrophy, you may end up using one of the following:

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 it is being done for another reason (i.e. accident, loss of teeth, etc), let me know and I can offer you some coding options.

Hope this helps!
Guest
#16 Posted : Friday, February 17, 2017 9:09:15 AM(UTC)
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wow that's great it is to build bone for an implant in 6 months!!

thank you so much!!!

Lee
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#17 Posted : Wednesday, February 21, 2018 4:08:34 PM(UTC)
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What is the medical code for D7951 if I had to have an extraction?
courtneydsnow
#18 Posted : Wednesday, February 21, 2018 5:41:39 PM(UTC)
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courtneydsnow

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Hi Guest!

D7951 - sinus augmentation with bone or bone substitutes via a lateral open approach
can be crosscoded to:
21210 - graft, bone; nasal, maxillary, or malar areas
*use -52 modifier for reduced services when bone is not obtained from the patient

Hope this helps!
Guest
#19 Posted : Wednesday, June 6, 2018 2:15:40 PM(UTC)
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i understand that medicare has three months global period for billing. what if I do sinus lift on both sides? can I? If yes, will i be reinbursed for both bone grafts?
courtneydsnow
#20 Posted : Monday, June 11, 2018 8:10:01 AM(UTC)
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courtneydsnow

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Hi Guest!

Yes, Medicare certainly does have a 90 day global period associated with HCPCS code E0486 (for custom made oral appliances for Obstructive Sleep Apnea), however I don't believe the global period is necessarily the same for surgical procedures (many insurers will have a 10 to 14 day global period associated with surgical procedures).

As for coverage availability and criteria for Medicare for sinus lifts - this will likely vary depending on your Medicare Part B jurisdiction. I would recommend visiting your Medicare Part B MAC's website and searching the LCD's for CPT 21210 to see if there is additional coverage information available.

Hope this helps!
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