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shemen9
#1 Posted : Tuesday, January 26, 2016 7:54:57 PM(UTC)
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shemen9

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I am having an issue with a medical claim from prior to the change to ICD 10. I submitted the claim using CPT S8262, which was denied as invalid code. I also know that the D7880 code is not covered for this insurance plan.

What code do I use?


courtneydsnow
#2 Posted : Wednesday, January 27, 2016 11:10:17 AM(UTC)
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courtneydsnow

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Hi shemen9!

What we are finding is that the code that is most commonly accepted by medical insurers currently for TMD type appliances since the S8262 discontinuation is D7880. However, some insurers are accepting the other codes listed below as well:

D7880 - occlusal orthotic device, by report

D7899 - unspecified TMD therapy, by report

Or, if the medical insurer says they won’t process the “D” codes (most will these days, but you will run into a few that won’t), you can try:

E1399 - Durable medical equipment, miscellaneous
21299 - Unlisted craniofacial and maxillofacial procedure
21499 - Unlisted musculoskeletal procedure, head
21089 - Unlisted maxillofacial prosthetic procedure

A narrative report explaining the treatment accompanying the claim is recommended since they are all "by report", “unlisted”, or "miscellaneous" codes.

It may be best to look up the insurers medical policy for Temporomandibular disorders and check the coding section of the policy to see if a specific code they accept is listed. For example, Aetna's medical policy for Temporomandibular disorders lists D7880 as an accepted HCPCS code is criteria is met: http://www.aetna.com/cpb/medical/data/1_99/0028.html
 1 user thanked courtneydsnow for this useful post.
shemen9 on 1/27/2016(UTC)
shemen9
#3 Posted : Wednesday, January 27, 2016 3:17:14 PM(UTC)
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shemen9

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Ni Courtney,

Thank you so much for your assistance. It is nice to know there to guide me through the maze

Donna

Edited by user Wednesday, January 27, 2016 3:19:41 PM(UTC)  | Reason: Not specified

courtneydsnow
#4 Posted : Wednesday, January 27, 2016 3:39:15 PM(UTC)
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courtneydsnow

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you're very welcome, anytime!
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#5 Posted : Monday, March 14, 2016 4:19:16 AM(UTC)
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#6 Posted : Monday, March 14, 2016 4:21:52 AM(UTC)
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