Nierman Practice Management Logo
Follow us on Facebook
Follow us on Twitter
Connect with us on Linked In
View demos and More on You Tube
DentalWriter Software Logo 1-800-879-6468
Login   Register Here

Notification

Icon
Error

2 Pages12>
New Topic Post Reply
bshunnarah
#1 Posted : Monday, September 26, 2016 9:59:07 AM(UTC)
Quote
bshunnarah

Rank: New Member

Joined: 8/23/2016(UTC)
Posts: 1

Is the cone beam CT SCAN covered on medical for Cancer screening, TMJ, sleep apnea?
If so what is the correct CPT code/dx code
courtneydsnow
#2 Posted : Monday, September 26, 2016 10:44:25 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,381

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi bshunnarah!

Great questions. Most of the medical policies we review list CT's as only medically necessary for pre-surgical for TMD, as usually listed as not medically necessary for sleep apnea.

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, 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 a good CPT code to use, or, many medical insurers will process the “D” codes for procedures when there is not a specific CPT code available.

For example, here are the “D” codes from HealthPartner’s medical policy for “Cone-beam computed tomography (CT) scan for medically-related dental services”

D0363 - Cone-Beam 3D multi image reconstruction
D0364 - Cone beam CT capture and interpretation with limited field of view - less than one whole jaw
D0365 - Cone beam CT capture and interpretation with field of view of one full dental arc - mandible
D0366 - Cone beam CT capture and interpretation with field of view of one full dental arch
- maxilla, with or without cranium
D0367 - Cone beam CT capture with interpretation with field of view of both jaws, with or without cranium
D0368 - Cone beam CT capture and interpretation for TMJ series including two or more exposures
D0380 - Cone beam CT image capture with limited field of view - less than one whole jaw
D0381 - Cone beam CT image capture with field of view of one full dental arch - mandible
D0382 - Cone beam CT image capture with field of view of one full dental arch - maxilla, with or without cranium
D0383 - Cone beam CT image capture with field of view of both jaws, with or without cranium
D0384 - Cone beam CT image capture for TMJ series including two or more exposures

Here is a link to the full policy:
https://www.healthpartners.com/public/coverage-criteria/cone-beam-scan.htm
Guest
#3 Posted : Wednesday, October 11, 2017 8:47:47 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 1,017

Was thanked: 16 time(s) in 15 post(s)
Are there any requirements prior to billing for CBCT's?
courtneydsnow
#4 Posted : Thursday, October 12, 2017 10:24:13 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,381

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Guest!

Many medical insurers do require that CBCT's are pre-authorized in order to be eligible for reimbursement.
Guest
#5 Posted : Tuesday, January 30, 2018 3:53:28 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 1,017

Was thanked: 16 time(s) in 15 post(s)
Will the medical insurance consider payment for the CBCT if it was done without pre-authorization ?

Edited by user Tuesday, January 30, 2018 3:55:33 PM(UTC)  | Reason: Not specified

courtneydsnow
#6 Posted : Tuesday, January 30, 2018 5:05:28 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,381

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Guest!

Great question. Yes that is certainly possible! Many insurers will require a pre-auth for CBCT, but not all.
Guest
#7 Posted : Wednesday, March 21, 2018 11:39:34 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 1,017

Was thanked: 16 time(s) in 15 post(s)
i know this post is a year old, but i came this across when i enter d0364. i did a root canal and this code was not covered thru delta dental. so the dentist is now charging me. I ask before if the root canal procedure is covered, they said yes. I feel this is a bait and switch. charging me 400 additional dollars.
courtneydsnow
#8 Posted : Wednesday, March 21, 2018 3:08:46 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,381

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Guest!

Do you know the reason delta dental denied it? (i.e. perhaps you could try to bill to your medical insurance first, and then try dental dental again if medical does not cover it with a copy of the EOB from medical)

Also - is your dentist in-network with delta dental? If they are in-network, they should know ahead of time what services are covered and not...
Guest
#9 Posted : Thursday, March 22, 2018 11:23:13 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 1,017

Was thanked: 16 time(s) in 15 post(s)
Hi,
I have a similar question..
What does insurance view as an "acceptable" reason for have a cone beam scan? What codes can be used to have a scan pre authorized?
(Besides Implant, Cancer, and TMJ)
courtneydsnow
#10 Posted : Thursday, March 22, 2018 4:28:37 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,381

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Guest!

Great question. We generally see coverage for CT scans for surgical cases, or at least when surgery is being contemplated. It depends on the insurer, but here is an example of some language from HealthPartner's medical policy titled:"Cone-beam computed tomography (CT) scan for medically-related dental services”


CBCT is covered for the following indications:

-Evaluation of dental implants when coverage criteria under the accidental dental medical coverage policy are met.
-Evaluation prior to one of the following oral surgery indications:
-Removal of maxillo-facial tumor, non-odontogenic cyst (cyst not originating from a tooth or
the closely surrounding tissues), neoplasm or other pathologic entities that, due to their
size and/or anatomic location, appear to encroach, impinge or are invested in/on critical
anatomic structures (e.g. inferior alveolar nerve, maxillary sinus);
-Arthroplasty of Temporomandibular (TM ) fossae or condyle, TM joint replacement;
-Developmental mid-face syndromes such as cleft palate, Treacher-Collins syndrome, etc;
-Surgical reconstruction after severe oral-facial trauma (such as injuries resulting from motor
vehicle accidents, gunshot wounds, boating accidents or other disfiguring trauma). In
addition, when CBCT is requested prior to an oral surgery listed as A-D above, one of the
following must also be satisfied:
-The panoramic radiograph indicates that a deviation from a routine surgical approach is
probable and further data necessary to plan such an approach; OR
-Information obtained by CBCT is considered critical in determining a surgical plan for
the avoidance of disruption, invasion, or fracture of a surrounding, critical oral-facial
structure.
-Evaluation prior to orthognathic surgery (to correct conditions of the jaw) when coverage
criteria under the orthognathic surgery coverage policy are met AND information obtained by
CBCT is considered critical in determining a surgical plan for the avoidance of disruption,
invasion or fracture of a surrounding, critical oral-facial structure.

Indications that are not covered include but may not be limited to:

-CBCT when used in conjunction with non-covered dental procedures including but not limited to dental implants or bone grafting in preparation for dental implants.
-CBCT for other medically-related dental indications not listed above as covered.

Now, as far as the code to use for a pre-auth:
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, 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 a good CPT code to use, or, many medical insurers will process the “D” codes for procedures when there is not a specific CPT code available.

For example, here are the “D” codes from HealthPartner’s medical policy:

D0363 - Cone-Beam 3D multi image reconstruction
D0364 - Cone beam CT capture and interpretation with limited field of view - less than one whole jaw
D0365 - Cone beam CT capture and interpretation with field of view of one full dental arc - mandible
D0366 - Cone beam CT capture and interpretation with field of view of one full dental arch
- maxilla, with or without cranium
D0367 - Cone beam CT capture with interpretation with field of view of both jaws, with or without cranium
D0368 - Cone beam CT capture and interpretation for TMJ series including two or more exposures
D0380 - Cone beam CT image capture with limited field of view - less than one whole jaw
D0381 - Cone beam CT image capture with field of view of one full dental arch - mandible
D0382 - Cone beam CT image capture with field of view of one full dental arch - maxilla, with or without cranium
D0383 - Cone beam CT image capture with field of view of both jaws, with or without cranium
D0384 - Cone beam CT image capture for TMJ series including two or more exposures

Here is a link to the full policy:
https://www.healthpartne...?contentid=AENTRY_045861

Hope this helps!
Bgonzalez
#11 Posted : Thursday, April 12, 2018 12:42:46 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 1,017

Was thanked: 16 time(s) in 15 post(s)
Hi there, i'VE been reading through most of these topics and still have some questions on filing CBCTs scan through Medical.

I understand the best code to use is 70486, however the diagnostic code to go along with it is what I need. We're an orthodontic office and when we take CBCTs we take them on patients who have impacted third molars or impacted cuspids. What would be the best diagnostic codes for that?

Also, most medical insurances do verbal prior authorizations, is that correct?
courtneydsnow
#12 Posted : Thursday, April 12, 2018 4:19:12 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,381

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Bgonzalez!

70486 may or may not be the best code to use. However, if you do choose to use that code to represent your CBCT's, then here are some diagnosis coding options for impacted teeth:
K01.1 - Impacted teeth
M26.31 - Crowding of fully erupted teeth
R68.84 - Jaw pain
G50.1 - Atypical facial pain
R52 - Pain, unspecified

And correct, many medical insurers do at least allow you to start the pre-authorization request over the phone. You may need to fax in supporting clinical documentation in order for them to approve the authorization request, but not always.

Hope this helps!
Guest
#13 Posted : Wednesday, September 12, 2018 8:34:00 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 1,017

Was thanked: 16 time(s) in 15 post(s)
Is it possible to take a CT scan and bill dental for a pano or fmx since you can pull these things from the scan?
courtneydsnow
#14 Posted : Friday, September 14, 2018 4:56:51 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,381

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Guest!

Great question. Yes you can certainly bill a pano from your CBCT scan. One practice to be weary of would be to bill multiple scans (pano, fmx, ceph, etc etc) instead of the CBCT code, as that could be viewed as unbundling. However, choosing a lesser code is typically not frowned upon.

Hope this helps!
Guest
#15 Posted : Thursday, August 8, 2019 5:14:47 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 1,017

Was thanked: 16 time(s) in 15 post(s)
Hello,
I am reading all the CBCT coding tips, super helpful. I worked in general dentistry office and looking for diagnostic codes for implant, extraction, sinus lift related CBCT.
Thanks
courtneydsnow
#16 Posted : Monday, August 12, 2019 10:35:43 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,381

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Guest!

No problem. The diagnosis code(s) will depend on the patients condition, however here are some common diagnostic codes we see for implant, extraction & sinus lifts:

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
K12.2 - Cellulitis and abscess of mouth
K04.6 - Periapical abscess with sinus
K04.7 - Periapical abscess without sinus
K04.1 - Necrosis of pulp
K04.2 - Pulp degeneration
K04.01 - Reversible pulpitis
K04.02 - Irreversible pulpitis
K05.211 - Aggressive periodontitis, localized, slight
K05.212 - Aggressive periodontitis, localized, moderate
K05.213 - Aggressive periodontitis, localized, severe
K05.219 - Aggressive periodontitis, localized, unspecified severity
K05.221 - Aggressive periodontitis, generalized, slight
K05.222 - Aggressive periodontitis, generalized, moderate
K05.223 - Aggressive periodontitis, generalized, severe
K05.229 - Aggressive periodontitis, generalized, unspecified severity
K05.311 - Chronic periodontitis, localized, slight
K05.312 - Chronic periodontitis, localized, moderate
K05.313 - Chronic periodontitis, localized, severe
K05.319 - Chronic periodontitis, localized, unspecified severity
K05.321 - Chronic periodontitis, generalized, slight
K05.322 - Chronic periodontitis, generalized, moderate
K05.323 - Chronic periodontitis, generalized, severe
K05.329 - Chronic periodontitis, generalized, unspecified severity
K05.10 - Chronic gingivitis, plaque induced
K05.11 - Chronic gingivitis, non-plaque induced
K02.3 - Arrested dental caries
K02.51 - Dental caries on pit and fissure surface limited to enamel
K02.52 - Dental caries on pit and fissure surface penetrating into dentin
K02.53 - Dental caries on pit and fissure surface penetrating into pulp
K02.61 - Dental caries on smooth surface limited to enamel
K02.62 - Dental caries on smooth surface penetrating into dentin
K02.63 - Dental caries on smooth surface penetrating into pulp
K02.7 - Dental root caries
K02.9 - Dental caries, unspecified
K03.81 - Cracked tooth
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
S03.2XXA - Dislocation of tooth, initial encounter
M26.34 - Vertical displacement of fully erupted tooth or teeth
M26.33 - Horizontal displacement of fully erupted tooth or teeth

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 trauma:
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

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 class


If these don't fit the bill with your patient's case, feel free to send me along some additional details and we can explore other coding options.

Hope this helps!
Steve
#17 Posted : Monday, October 28, 2019 5:39:54 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 1,017

Was thanked: 16 time(s) in 15 post(s)
Hi,
I needed to have a cbct to determine if I needed a root canal. An x-ray was inconclusive from my regular dentist. So I was referred to the endodontist to get a cbct
I just got my EOB and the endodontic office billed it D0364 (Cone beam CT capture) and it was not covered. They did warn me that it may not be covered.
So when they told me that I did call my insurance before hand (Horizon BCBS), and all they could tell me is that it was covered under some circumstances and some not, they could not tell me specifically what codes were covered, etc.
I did require a root canal and the endodontist did use the cbct in performing the root canal, I was having sinus headaches due to sinus infection by the roots.

Are there any other codes that they can bill it under that may be covered? My heath insurance is also Horizon BCBS but they did not submitted under my heath plan.


courtneydsnow
#18 Posted : Tuesday, October 29, 2019 8:08:33 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,381

Thanks: 39 times
Was thanked: 47 time(s) in 47 post(s)
Hi Steve!

I was able to locate Horizon BCBS's medical policy titled "Cone Beam Computed Tomography" - The codes listed in the medical policy actually do include the one that your endodontist used (D0364). Some medical insurers won't process codes beginning with a "D" and the practice uses a CPT code instead (typically either 70486, 76102, or 76497), however it appears Horizon BCBS will accept the "D" codes since they are listed in the medical coverage policy.

Here is a link to the medical policy for CBCT:
https://services3.horizon-bcbsnj.com/hcm/medpol2.nsf/0/717EBE2E1F44784C8525849B003501B5?opendocument

The policy states:

"I. Cone Beam CT is considered medically necessary as a diagnostic modality for the detection of the following specific maxillofacial conditions that may require surgery.

Jaw Reconstruction- particularly atrophic maxillary or mandible reconstruction
Facial Bone Fractures
Temporal Mandibular Joint (TMJ) Disorders
Cysts and tumors of the jaw
Congenital Cleft Palate


II. Other uses of Cone Beam CT would be considered Dental procedures, except where explicitly stated in the contract."

It appears your medical insurer may consider this dental in nature based on the coverage criteria in the CBCT medical policy.


Now, if this is going to be submitted to the medical insurer, you will also need diagnosis codes. Based on what you described for sinus infection and headaches, here are some related diagnosis coding options:

R51 - Headache
J01.00 - Acute maxillary sinusitis, unspecified
J01.01 - Acute recurrent maxillary sinusitis
J01.10 - Acute frontal sinusitis, unspecified
J01.11 - Acute recurrent frontal sinusitis
J01.20 - Acute ethmoidal sinusitis, unspecified
J01.21 - Acute recurrent ethmoidal sinusitis
J01.30 - Acute sphenoidal sinusitis, unspecified
J01.31 - Acute recurrent sphenoidal sinusitis
J32.0 - Chronic maxillary sinusitis
J32.1 - Chronic frontal sinusitis
J32.2 - Chronic ethmoidal sinusitis
J32.3 - Chronic sphenoidal sinusitis
J32.4 - Chronic pansinusitis
J32.8 - Other chronic sinusitis
J32.9 - Chronic sinusitis, unspecified


Hope this helps!

Guest
#19 Posted : Tuesday, October 29, 2019 9:17:17 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 1,017

Was thanked: 16 time(s) in 15 post(s)
Thank you very much. I will talk to my endodontist office and see what they can do.

Steve
Guest
#20 Posted : Friday, December 6, 2019 9:11:00 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 1,017

Was thanked: 16 time(s) in 15 post(s)
I had a cone beam D0367 scan done for dental implants because I lost multiple teeth one to infection and another the filling came out and the tooth cracked so it was extracted. What would be the diagnosis code? My health insurance is Empire of BCBS federal employee program. Any help would be greatly appreciated

Edited by user Friday, December 6, 2019 9:12:32 PM(UTC)  | Reason: Correction

Quick Reply Show Quick Reply
2 Pages12>
New Topic Post Reply
Forum Jump  
You can post new topics in this forum.
You can reply to topics in this forum.
You can delete your posts in this forum.
You can edit your posts in this forum.
You cannot create polls in this forum.
You can vote in polls in this forum.