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Guest
#1 Posted : Tuesday, February 2, 2016 1:09:43 PM(UTC)
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Guest

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I am trying to pre authorize a sinus lift through health insurance(Kaiser). I think 21210 is the right code to use. This is my first time trying to claim dental work through a health insurance. Any pointer and tips will be helpful

Thank you
courtneydsnow
#2 Posted : Tuesday, February 2, 2016 4:42:06 PM(UTC)
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courtneydsnow

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Hi guest!

No problem, below are some coding options for you:

D6104 = Bone Graft at Time of Implant Placement

D7952 = Sinus Augmentation Via a Vertical Approach

D7951 = Sinus augmentation with bone or bone substitutes via a lateral open approach

D7953 = Bone Replacement Graft for Ridge Preservation

and:

21210 = Graft, bone; nasal, maxillary or malar areas (includes obtaining graft) “sinus lift”

21215 = Graft, bone; mandible (includes obtaining graft)

So - some insurers will prefer you use the CPT codes for the bone graft at time of implant placement and the sinus augmentation, but you will also find insurers that will prefer you use the "D" codes listed above on the medical claim form when billing for these procedures! Also, some insurers may consider these procedures "Dental in Nature Oral Surgery" services, depending on their medical policies guidelines.

For example, here is a link to Aetna's medical policy titled "Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans", and include sinus lifts:
http://www.aetna.com/cpb/medical/data/1_99/0082.html

Here is another example, UHC Oxford policy titled "DENTAL AND ORAL SURGICAL PROCEDURES"
https://www.oxhp.com/secure/policy/dental_and_oral_surgical_procedures.pdf

Hope this helps, have a great day!
Guest
#3 Posted : Wednesday, October 25, 2017 6:57:38 PM(UTC)
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What diagnosis code do you use?
courtneydsnow
#4 Posted : Monday, October 30, 2017 8:48:34 AM(UTC)
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courtneydsnow

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Hi Guest!

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

For example, if the patient has atrophy, some coding options are:

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 these options above don't fit the bill for your patient, if you'd like to provide some additional detail on their condition, I would be happy to offer some coding options.

Hope this helps!
Guest
#5 Posted : Monday, July 16, 2018 10:13:35 AM(UTC)
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I was told that 99144 and 99145 are old codes for anestesia and that they were updated, though I was not told what they were updated to. Do you know the new cpt codes that would cover these? I originally cross referenced D9243.

Thanks
courtneydsnow
#6 Posted : Tuesday, July 24, 2018 7:54:38 AM(UTC)
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courtneydsnow

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Hi Guest!

No problem. Below are the updated coding options for moderate sedation services:

99151
Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age

99152
Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older

99153
Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; each additional 15 minutes intraservice time (list separately in addition to code for primary service)

99155
Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age

99156
Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older

99157
Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intraservice time (list separately in addition to code for primary service)


Hope this helps!
RTilly
#7 Posted : Thursday, June 13, 2019 2:19:43 PM(UTC)
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Hi Courtneydsnow,

Your amazing responses are really helpful.

1. Do you have code for Anthem BlueCross PPO plan ?
2. Can the pre-approval letter submit by patient instead of Doctor?
3. If submission has to be filed by doctor, does it need to be a MD ? Or DDS? or dentist can, too ?

Thanks.
courtneydsnow
#8 Posted : Tuesday, June 18, 2019 3:44:31 PM(UTC)
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Hi RTilly!

Thanks for the kind words!

Great questions. The CPT code to use for sinus lifts:
21210 - Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)
**use modifier -52 for reduced services when bone is not obtained from patient

The pre-authorization request is typically submitted by the provider instead of the patient, as they will need information like your NPI and Tax ID to process this request. While some insurers may require that the patient's PCP initiates these types of requests to out of network providers, most medical insurers will accept the request from the dentist.

Hope this helps!


Guest
#9 Posted : Thursday, June 27, 2019 11:42:42 PM(UTC)
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Can anyone help me with a question. I have to have a sinus lift and I’ve been told that my dental plan which is Aetna will not cover it. I suffer from osteoporosis and acid reflex which has contributed to my loss of bone. Could I file a claim through my health insurance plan or is there another option to file through my dental plan. Any help regarding this matter is greatly appreciated. Thank you

Edited by user Thursday, June 27, 2019 11:48:01 PM(UTC)  | Reason: Not specified

courtneydsnow
#10 Posted : Friday, June 28, 2019 9:14:38 AM(UTC)
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courtneydsnow

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Hi Guest!



I found the following language in Aetna's medical policy titled: "Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans":
http://www.aetna.com/cpb/medical/data/1_99/0082.html

It states:

"The following dental services are considered not covered under the medical plan regardless of whether they accompany medically necessary reconstructive surgery:

- Dental implants (except as specified in the certificate of coverage). Most medical plans do not cover the routine replacement of teeth via surgical placement of a dental implant body. In addition, any procedures (e.g., bone replacement graft,sinus lift surgery, soft tissue graft, and barrier membrane placement) considered as adjunctive procedures to the surgical placement of the dental implant body are also not covered. For those medical plans that do cover routine replacement of teeth by dental implants, the only procedure covered by the medical plan related to the dental implant is the surgical placement of the dental implant body (replacement of the missing root). The restorative procedure (replacement of the missing crown) is considered a dental expense;
- Fluoride carrier."



However, if the reason for the sinus lift is not relating to implant placement, it would certainly be worth submitting a pre-authorization for review to your medical insurer.

Hope this helps!
Guest
#11 Posted : Friday, June 28, 2019 12:38:13 PM(UTC)
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Thank you for your help, very much appreciated
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