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Guest
#1 Posted : Tuesday, January 19, 2021 11:35:48 AM(UTC)
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Guest

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Hi,

My insurance company will cover TMD treatment on the medical side but not the dental. I called my insurance company to confirm this and they confirmed but now that my dentist is sending in a claim they are denying it. I went to an orthodontist and he diagnosed me with TMD and determined he could correct my bite with braces which in turn would help with the pain from the TMD. They wrote a letter of medical necessity but I think they are using the incorrect codes when submitting the claim.

Do they need to use a diagnosis code as well as a procedure code when submitting the claim or will a procedure code work alone? I know they sent a procedure code D7880 which after speaking with my ins company I know isn't the correct code because my braces aren't a removeable appliance.

Do you have any ideas on what diagnosis code and procedure code we could try together for treatment of TMD with braces.

Thanks!

courtneydsnow
#2 Posted : Tuesday, January 19, 2021 12:26:45 PM(UTC)
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courtneydsnow

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Hi Guest!

Great question. Unfortunately what we typically see with medical coverage of TMJ disorder treatment is that orthodontic treatment for TMJ disorders are considered non-covered.
As you mentioned, many medical coverage policies do state they will cover "removable intra-oral appliances" to treat TMJ disorders, as well other treatments such as trigger point injections.

For example, Aetna's medical policy titled "Temporomandibular Joint Disorders" states that "Orthodontic/bite adjustment services and orthodontic fixed appliances" is non-covered, found under the section IV B:
http://www.aetna.com/cpb/medical/data/1_99/0028.html

"Aetna considers the following experimental and investigational for diagnosis and treatment of TMJ disorders:
28. Orthodontic/bite adjustment services and orthodontic fixed appliances"


Having said all of that - not all medical policies are created equal! There will be variance in what services are covered and not from policy to policy.

To answer your coding question - yes there should be both diagnosis (ICD-10) and procedure/equipment codes (CPT & HCPCS) included with the medical claim.

There are several diagnosis codes to choose from when it comes to TMJ disorders for your provider to choose from, such as:

M26.611 - Adhesions and ankylosis of right temporomandibular joint
M26.612 - Adhesions and ankylosis of left temporomandibular joint
M26.613 - Adhesions and ankylosis of bilateral temporomandibular joint

M26.621 - Arthralgia of right temporomandibular joint
M26.622 - Arthralgia of left temporomandibular joint
M26.623 - Arthralgia of bilateral temporomandibular joint

M26.631 - Articular disc disorder of right temporomandibular joint
M26.632 - Articular disc disorder of left temporomandibular joint
M26.633 - Articular disc disorder of bilateral temporomandibular joint

M26.641 Arthritis of right temporomandibular joint
M26.642 Arthritis of left temporomandibular joint
M26.643 Arthritis of bilateral temporomandibular joint

M26.651 Arthropathy of right temporomandibular joint
M26.652 Arthropathy of left temporomandibular joint
M26.653 Arthropathy of bilateral temporomandibular joint

M26.69 - Other specified disorders of temporomandibular joint


There are also symptom type codes, such as:
M79.11 - Myalgia of mastication muscle
R51.09 - Headache, unspecified


Now, as for the procedure/equipment code for braces: there actually is not a specific CPT or HCPCS code we are aware of to represent braces. So, practices may either use the "D" code (dental code) on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), or can use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures


Hope this helps!
Guest
#3 Posted : Tuesday, January 19, 2021 12:45:51 PM(UTC)
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Guest

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Thanks so much for your help! it is worth a try!
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