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Guest
#1 Posted : Friday, April 21, 2017 11:17:44 AM(UTC)
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Guest

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Hi, patient got bone grafting procedure (D7953) to get dental implant placement however his dental insurance denied saying that this procedure is a medical benefit. So, I submit the claim to his Medical Insurance.Now medical insurance is asking the diagnosis code for this treatment. There is no accident or trauma. What could be the diagnosis code for medical?

P.S.: Treating dentist is an oral surgeon

Thanks
Gina
courtneydsnow
#2 Posted : Monday, April 24, 2017 8:28:46 AM(UTC)
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courtneydsnow

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Hi Gina!

Great question. The diagnosis code will depend on why the bone graft and implant are needed. Many times the diagnosis code for bone graft is atrophy, but also may be something else depending on what the patient's condition is.

For example, here are the atrophy codes below:

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 bone graft and implant are being done for a different reason, let me know and I'd be happy to offer you some coding options.
Guest
#3 Posted : Tuesday, April 9, 2019 2:57:45 PM(UTC)
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Hi, I am a patient that had an implant procedure approx. 5 years ago. However in October 2018 with xray It was found that the bone around the implant deteriorating thus I needed to have this re done. As a result my dental insurance see the new bone grafting as a medical procedure but the dentist that completed the procedure does not know what diagnosis code to use can you help us. The procedure code he used was D7953
Thank you, Leslie
courtneydsnow
#4 Posted : Wednesday, April 10, 2019 10:25:49 AM(UTC)
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courtneydsnow

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Hi Leslie!

Based on what you described, here are some possible diagnosis coding options:

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
M27.61 - Osseointegration failure of dental implant
M27.62 - Post-osseointegration biological failure of dental implant
M27.63 - Post-osseointegration mechanical failure of dental implant
M27.69 - Other endosseous dental implant failure


Also, for the procedure coding:
D7953 - bone replacement graft for ridge preservation - per site
Can be cross coded to:
21210 - Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)
21215 - Graft, bone; mandible (includes obtaining graft)
**use modifier -52 for reduced services when bone is not obtained from patient

Hope this helps!
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