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Cindi
#1 Posted : Thursday, November 19, 2015 2:33:19 PM(UTC)
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I am having trouble determining what diagnosis codes to use for Sinus lifts 21210 and bone grafting and do they have to be pre authorized?
thank you
Our dentist regularly does grafting following extractions on Max when an Implant is going to be placed
courtneydsnow
#2 Posted : Friday, November 20, 2015 1:02:52 PM(UTC)
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courtneydsnow

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Hi Cindi!

Great question. The diagnosis code(s) used are actually going to completely depend on the patient and what their condition is!

For example, if the issue the patient is presenting with is a retained root, you can use ICD-10 diagnosis code K08.3 - Retained dental root

Then, since a retained root can cause infection and pain, if there is any infection and/or pain present, you can use additional ICD-10 codes for those, for example: K12.2 - Cellulitis and abscess of mouth, and/or G89.1 - Acute pain, not elsewhere classified.

And as for the grafting/sinus lift codes –

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

For both 21210 and 21215, when bone is not obtained from the patient, use modifier -52 (reduced service).

Whether or not a pre-authorization is required will depend on the insurer. The best thing to do is to ask the insurer when doing your benefit verification call if a pre-authorization is required for the code(s) you select.

Some insurers will list in their medical policies for bone grafting/oral surgery service that bone grafting will be deemed not medically necessary for placement of implants, so that is something to keep and eye out for.

Hope this helps, have a great day!
Guest
#3 Posted : Tuesday, May 24, 2016 3:20:17 PM(UTC)
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Do you know what the IC10 code is for D3431 - Biological Material?

Thank you!
courtneydsnow
#4 Posted : Wednesday, May 25, 2016 8:29:39 AM(UTC)
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Hi Guest!

D3431 - biologic materials to aid in soft and osseous tissue regeneration in conjunction with periradicular surgery

As far as what ICD-10 diagnosis code(s) to use, this will completely depend on your patient! Basically, what is the reason/diagnosis that the patient is getting the service(s) done?

For example, if it is due to atrophy of the mandible or maxilla, you may use one of the following ICD-10 diagnosis codes:

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 is for another reason, let me know what it is and I happy to help you locate an appropriate diagnosis code.

Hope this helps, have a great day!
Guest
#5 Posted : Tuesday, May 31, 2016 2:28:14 PM(UTC)
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Thank you for answering my question. We used this dental code: D3431 Biological Materials to aid in osseous and soft tissue. I need to know what medical code to use in conjunction with this code.

Thank you for your help!

Tonya
courtneydsnow
#6 Posted : Tuesday, May 31, 2016 3:23:13 PM(UTC)
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courtneydsnow

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Hi Tonya!

No problem!

D3431 - biologic materials to aid in soft and osseous tissue regeneration in conjunction with periradicular surgery

The code listed above does not have 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 one of the CPT codes below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures
99070 - 99070 - Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)

Hope this helps, have a great day!
Guest
#7 Posted : Tuesday, April 11, 2017 2:34:21 PM(UTC)
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Patient will need a sinus lift to place an implant. I need the ICD10 and CPTcode for this procedure. Dental code is D6010 implant and D7951 for sinus lift.

Thank you
Carmen
mbrzezinski
#8 Posted : Tuesday, April 11, 2017 4:02:54 PM(UTC)
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Hi Carmen!

D6010 - surgical placement of implant body: endosteal implant
can be crosscoded to:
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)
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

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
#9 Posted : Monday, October 16, 2017 3:27:21 PM(UTC)
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What is the ICD 10 code when the 21210 procedure is done for loss of tooth?

(D7951 and D6010)
courtneydsnow
#10 Posted : Monday, October 16, 2017 4:46:48 PM(UTC)
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Hi Guest!

Here are some ICD-10 coding options for you below for partial loss of teeth:

Partial loss of teeth, due to trauma:
o K08.411 - Partial loss of teeth due to trauma, class I
o K08.412 - Partial loss of teeth due to trauma, class II
o K08.413 - Partial loss of teeth due to trauma, class III
o K08.414 - Partial loss of teeth due to trauma, class IV
o K08.419 - Partial loss of teeth due to trauma, unspecified class

Partial loss of teeth, due to periodontal diseases:
o K08.421 - Partial loss of teeth due to periodontal diseases, class I
o K08.422 - Partial loss of teeth due to periodontal diseases, class II
o K08.423 - Partial loss of teeth due to periodontal diseases, class III
o K08.424 - Partial loss of teeth due to periodontal diseases, class IV
o K08.429 - Partial loss of teeth due to periodontal diseases, unspecified class

Partial loss of teeth, due to caries:
o K08.431 - Partial loss of teeth due to caries, class I
o K08.432 - Partial loss of teeth due to caries, class II
o K08.433 - Partial loss of teeth due to caries, class III
o K08.434 - Partial loss of teeth due to caries, class IV
o K08.439 - Partial loss of teeth due to caries, unspecified class

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

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


Hope this helps!
Guest
#11 Posted : Wednesday, November 8, 2017 1:06:12 PM(UTC)
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Jen
#12 Posted : Wednesday, February 14, 2018 3:18:19 PM(UTC)
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Good Afternoon,

I am billing a 21210 to medical? What dx code would you use?
We are doing a sinus lift for a implant.

Thank you.
courtneydsnow
#13 Posted : Thursday, February 15, 2018 9:44:42 AM(UTC)
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courtneydsnow

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Hi Jen!

The diagnosis code(s) to use depends on the patient's condition.... basically - what is the condition/reason the services are being done?

For example, if the sinus lift is being performed due to atrophy, here are the mild, moderate, and severe ICD-10 diagnosis codes for atrophy of the mandible and maxilla:
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 the sinus lift is being performed for a different reason/condition, let me know and I am happy to help you with some coding options.

Hope this helps!
Guest
#14 Posted : Monday, January 7, 2019 11:07:13 PM(UTC)
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Can you dive into a little about the Classes and how to differentiate between them?

For example:

Partial loss of teeth, due to periodontal diseases:
o K08.421 - Partial loss of teeth due to periodontal diseases, class I
o K08.422 - Partial loss of teeth due to periodontal diseases, class II
o K08.423 - Partial loss of teeth due to periodontal diseases, class III
o K08.424 - Partial loss of teeth due to periodontal diseases, class IV
o K08.429 - Partial loss of teeth due to periodontal diseases, unspecified class

Partial loss of teeth, due to caries:
o K08.431 - Partial loss of teeth due to caries, class I
o K08.432 - Partial loss of teeth due to caries, class II
o K08.433 - Partial loss of teeth due to caries, class III
o K08.434 - Partial loss of teeth due to caries, class IV
o K08.439 - Partial loss of teeth due to caries, unspecified class

Thanks!
courtneydsnow
#15 Posted : Tuesday, January 8, 2019 9:50:26 AM(UTC)
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courtneydsnow

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Hi Guest!

No problem - here is a link to a presentation that goes more into detail!

https://www.prosthodontics.org/assets/1/7/ACP_PDI_Partial_Edentulism1.pdf
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