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Guest
#21 Posted : Wednesday, July 12, 2017 3:51:21 PM(UTC)
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Hi,

I have a patient who has congenitally missing laterals. I would appreciate direction in code/diagnosis for submitting a Pre-D for implant/abut/crown. I have a pre-approval from her dental insurance ans she is hoping to file medical as a secondary.

Thank You.
Guest
#22 Posted : Wednesday, July 12, 2017 3:53:06 PM(UTC)
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Hi,

I have a patient who has congenitally missing laterals. I would appreciate direction in code/diagnosis for submitting a Pre-D for implant/abut/crown. I have a pre-approval from her dental insurance and she is hoping to file medical as a secondary.

Thank You.
courtneydsnow
#23 Posted : Wednesday, July 12, 2017 4:02:36 PM(UTC)
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Hi guest!

The ICD-10 diagnosis code for congenitally missing teeth is:

K00.0 - Anodontia

As for the procedures you mentioned, crown/abut do not have direct crosscodes we are aware of, 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), but for the medical insurers who won't accept the "D" codes, you can try the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures

As for the implant:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3or less)
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more)


Hope this helps!
Guest
#24 Posted : Thursday, July 13, 2017 6:14:33 AM(UTC)
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Thank you so much! This is a tremendous help.

Missing Laterals Guest
Olivia
#25 Posted : Tuesday, August 15, 2017 11:43:35 AM(UTC)
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We have a patient who came to us with an edentulous tooth space and now would like an implant placed. It is our understanding that the tooth was pulled some years ago. There is adequate bone height and volume (so no atrophy). His dental insurance requires we bill medical first however I cannot seem to find an ICD-10 code to support the implant placement as we did not pull the tooth and there is nothing medically "wrong" or notated in the chart for the necessity of implant placement.

Do you have any suggestions as to which ICD-10 code we could use?

Edited by user Tuesday, August 15, 2017 11:44:40 AM(UTC)  | Reason: typo

courtneydsnow
#26 Posted : Tuesday, August 15, 2017 12:05:11 PM(UTC)
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Hi Olivia!

Here are some coding options to consider:

Partial loss of teeth, due to other specified cause:
K08.491 - Partial loss of teeth due to other specified cause, class I
K08.492 - Partial loss of teeth due to other specified cause, class II
K08.493 - Partial loss of teeth due to other specified cause, class III
K08.494 - Partial loss of teeth due to other specified cause, class IV
K08.499 - Partial loss of teeth due to other specified cause, unspecified

Partial loss of teeth, unspecified cause:
K08.401 - Partial loss of teeth, unspecified cause, class I
K08.402 - Partial loss of teeth, unspecified cause, class II
K08.403 - Partial loss of teeth, unspecified cause, class III
K08.404 - Partial loss of teeth, unspecified cause, class IV
K08.409 - Partial loss of teeth, unspecified cause, unspecified class

Hope this helps!

Guest
#27 Posted : Monday, October 9, 2017 11:25:29 PM(UTC)
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Hi - I have a question about medical coding. Patient had a bridge from 11-14 that was failing, root decay on 14 and periodontal issues at 11. Tooth #9 also had some decay (10 is already missing, cantilever bridge 10-11), Teeth #9, 11, 14 were extracted with bone grafting and immediate implant placement. Eventual treatment plan will be implant supported prosthesis (not done by our office). For CPT codes I think I need to use 41827-26 for the extractions, 21210-52 for bone grafting, and 21248 for implants. I'm not sure what to use for ICD 10 codes? Any help?
courtneydsnow
#28 Posted : Wednesday, October 11, 2017 8:04:47 AM(UTC)
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Hi Guest!

The codes you listed for bone graft & implant would be appropriate:

21210 - graft, bone; nasal, maxillary, or malar areas (modifier -52 for reduced services when bone is not obtained from patient)
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3or less)


41827 would not be an appropriate code for tooth extractions, as the description of that code is: Excision of lesion or tumor dentoalveolar structures; with complex repair

For tooth extractions, there is not direct crosscodes we are aware of, 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 try the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures


As for the ICD-10 diagnosis codes, this will depend on the patient & their condition - basically - what issues with the patient's dentition is the reason the patient receiving these services?

If you'd like to give me some details on the patient's condition, I would be happy to offer you some coding options.
Guest
#29 Posted : Tuesday, October 17, 2017 12:07:13 PM(UTC)
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Hi!

I'm trying to figure out how to bill BCBS for a patient using his medical coverage. He is a young man that was born without several adult teeth. The implants have already been placed, now I am working on codes for the restoration. He will have individual implants crowns and implant bridges. Can you help me with the best way to submit this claim? ICD 10 codes to be used?

Nina

Edited by user Tuesday, October 17, 2017 12:08:21 PM(UTC)  | Reason: Not specified

courtneydsnow
#30 Posted : Thursday, October 19, 2017 7:30:49 AM(UTC)
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Hi Guest!

The ICD-10 diagnosis code for Anodontia is: K00.0

As for the CPT procedure codes, there are not specific CPT codes for implant crowns & bridges we are aware of. 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 try the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures

Hope this helps!
Guest
#31 Posted : Tuesday, November 28, 2017 4:13:53 PM(UTC)
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Hello,

I'm trying to bill out an emergency visit (D0140) and a flipper (D5821) due to a dirt bike accident. Can you please help me with CPT and diagnosis codes.

Thanks
mbrzezinski
#32 Posted : Tuesday, November 28, 2017 5:59:27 PM(UTC)
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Hi Guest!
I need a little more detail to help with diagnosis codes. Can you please tell me if the pt. was the driver or a passenger of the dirt bike? were they in traffic? why did the pt. need the partial... did they fracture or loose teeth in the accident?

Thank you
Guest
#33 Posted : Tuesday, November 28, 2017 6:48:49 PM(UTC)
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Hello,

He was the driver of the dirt bike. I don't believe he was in traffic. Yes he fractured teeth and he lost some so we are making a temporary flipper for him to fill the space until he is old enough for an implant. This pt is 16 years old.
Thanks!
mbrzezinski
#34 Posted : Wednesday, November 29, 2017 9:15:29 AM(UTC)
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Thank you for the additional information!

Here is what I found based on the accident.

ICD-10-CM Diagnosis Code V86.56
Driver of dirt bike or motor/cross bike injured in nontraffic accident
Driver of dirt bike or motor/cross bike injured nontraffic


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

Partial loss of teeth, due to other specified cause:
K08.491 - Partial loss of teeth due to other specified cause, class I
K08.492 - Partial loss of teeth due to other specified cause, class II
K08.493 - Partial loss of teeth due to other specified cause, class III
K08.494 - Partial loss of teeth due to other specified cause, class IV
K08.499 - Partial loss of teeth due to other specified cause, unspecified

Partial loss of teeth, unspecified cause:
K08.401 - Partial loss of teeth, unspecified cause, class I
K08.402 - Partial loss of teeth, unspecified cause, class II
K08.403 - Partial loss of teeth, unspecified cause, class III
K08.404 - Partial loss of teeth, unspecified cause, class IV
K08.409 - Partial loss of teeth, unspecified cause, unspecified class

D0140 - limited oral evaluation - problem focused
Can be crosscoded to:
99201 - Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
or
99211 - Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.

99058- Emergency care
Or
99050 Emergency Care after hours
Use in addition to the evaluation and management code

D5821 - interim partial denture (mandibular)

The code listed above does not have a direct crosscode we are aware of, 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 try the CPT codes below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures

Hope this helps!
Guest
#35 Posted : Wednesday, November 29, 2017 10:58:59 AM(UTC)
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That was more than helpful !! Thank You so much for your time :)
Guest
#36 Posted : Friday, February 16, 2018 12:04:58 PM(UTC)
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What about an ER patient had a seizure and two front teeth came loose. The doctor reimplanted the two teeth? What procedure code should I use?
courtneydsnow
#37 Posted : Wednesday, February 21, 2018 10:16:09 AM(UTC)
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Hi Guest!

D7270 - Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth

In Aetna's crosswalk for "Oral Surgery Medical In Nature", the crosscode for D7270 is listed as:

21140 - Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)

or you can use the CPT codes below and include a narrative report describing the procedure(s):
41899 - Unlisted procedure, dentoalveolar structures

Hope this helps!
Guest
#38 Posted : Thursday, January 31, 2019 2:48:49 PM(UTC)
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Hi- Im looking for a medical procedure code and diagnosis code for a 12 yo diabled boy who fell onto some poorly placed metal bleachers at an indoor sports complex and cracked 2 front teeth in half. His disability required him to have the procedure done at a children's hospital a month after the event where he was placed under general anesthesia.

Dental insurance will not pay for the hospital stay (dental proc code D9420 hosp/surg ctr calls) and it seems like something medical should pay for but they keep kicking it back to dental because of codes-- so need xref and diag code..(im thinking 99221 + K08.411 - Partial loss of teeth due to trauma, class I--???

Thanks for any help..

Edited by user Thursday, January 31, 2019 3:04:47 PM(UTC)  | Reason: clarification

courtneydsnow
#39 Posted : Friday, February 1, 2019 10:21:16 AM(UTC)
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Hi Guest!

No problem, based on what you described, here are some ICD-10 diagnosis coding options for you:

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

It sounds like fractures from your description, but if there were teeth lost:

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
K08.419 - Partial loss of teeth due to trauma, unspecified class

(if the class isn't documented/known, choose the unspecified class option)

As for the fall:

W10.8XXA - Fall (on) (from) other stairs and steps, initial encounter
W10.8XXD - Fall (on) (from) other stairs and steps, subsequent encounter
W10.8XXS - Fall (on) (from) other stairs and steps, sequela


As for hospital care CPT codes:
99221 - hospital care, new, level 1
99222 - hospital care, new, level 2
99223 - hospital care, new, level 3
99231 - hospital - subseq., level 1
99232 - hospital - subseq., level 2
99233 - hospital - subseq., level 3


Hope this helps!
Guest
#40 Posted : Wednesday, June 26, 2019 8:26:09 PM(UTC)
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I am the patient and need help with getting my dental covered by my medical and there are NO dental offices in my county that know how to bill medical for anything. I fell due to having a bad ankle joint (it was very loose and weak) and I’ve had the joint surgically repaired so there is an Ortho that has diagnosed me with this issue and used codes 717.87 and M25.373 for diagnosis. When I fell I busted one tooth completely to the gum line(root left), 2 teeth pretty close to the gum line, had a crown on one of the teeth and the pieces of tooth broke other teeth when I slammed my chin. I was on a ladder and when I put my weight onto my right ankle and lifted up my left leg and fell due to the pain in my ankle weight bearing. I hit my teeth on one ladder rung and my chin on the next. I am trying to figure out what codes need to be used for extraction (normal and surgical), and for all the dental implant stuff and what diagnosis codes to use. I’m a medical assistant very familiar with billing but was never taught the dental side of medical billing. I appreciate any and all help you are able to provide and insurance is BC/BS employer provided PPO.
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