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Guest
#1 Posted : Friday, November 18, 2022 3:05:28 PM(UTC)
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Guest

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Hello,

My son has TMJ on both sides. We need to submit a claim for reimbursement to medical insurance, that cover TMJ.
We need to convert CDP to CPT and provide diagnosis code. Its very challenging to find the correct codes, specifically diagnosis codes.
What are CPT and diagnosis codes for following:
D150
D9310
D367
D350
D7880

Really appreciate your help.

Thank you.
MZ
courtneydsnow
#2 Posted : Wednesday, November 30, 2022 12:39:30 PM(UTC)
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courtneydsnow

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Hi MZ!

D0150 - comprehensive oral evaluation - new or established patient
and
D9310 - consultation - diagnostic service provided by dentist or physician other than requesting dentist or physician
can be crosscoded to a new or established patient evaluation & management (E&M) codes - 99202-99205 (new patients), or 99211-99215 (established patient):

New patients:
99202 – 15-29 mins
99203 – 30-44 mins
99204 – 45-59 mins
99205 – 60-74 mins

Established patients:
99212 – 10-19 mins
99213 – 20-29 mins
99214 – 30-39 mins
99215 – 40-54 mins


D0367 - Cone beam CT capture with interpretation with field of view of both jaws, with or without cranium

There is actually not currently a specific CPT code for CBCT……the closest CPT code is: “70486 - Computed tomography, maxillofacial area; without contrast material”. Many offices have been using this for some time for CBCT, and some insurers require this code to be used for CBCT (i.e. UHC). However, some medical insurers are auditing that code when used for CBCT because the description does not specify “cone beam”.

So, “76497 - Unlisted computed tomography procedure (eg, diagnostic, interventional)” is an option to use (keep in mind you'll need to provide a narrative description for unlisted codes).



D0350 - 2D oral/facial photographic image obtained intra-orally or extra-orally

The code listed above does not have a direct crosscode we are aware of - 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


D7880 - occlusal orthotic device, by report
many medical insurers actually accept code D7880 for oral appliances to treat TMJ disorders! That may sound funny, i know, since D7880 is a CDT code, but we have seen many medical insurers process that code. Keep in mind, not all patient policies include coverage for treatment of TMJ disorders, but many do. And you'll want to be sure to include a narrative report describing the procedure that code is being used to represent.


Now, as for the diagnosis codes, there are 16 TMJ disorder diagnosis codes to choose from:

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


If your son has been diagnosed with a TMJ disorder, you'll want your doctor to select at least one of the above. Then, there is typically additional pain/symptoms type diagnosis codes that go along with these disorders, for example:
M79.11 - Myalgia of mastication muscle
G50.1 - Atypical facial pain
R51.9 - Headache, unspecified


I hope this helps!
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