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Last 10 Posts (In reverse order)
courtneydsnow Posted: Thursday, July 22, 2021 11:57:00 AM(UTC)
 
Hi Tiffany!

Ok great thanks for those details! Based on what you described, it looks like you best option to describe the fall is:

W18.39XA - Other fall on same level, initial encounter

Hope this helps!
Tiffany Posted: Thursday, July 22, 2021 7:47:47 AM(UTC)
 
Thank you so much Courtney!

The patient was actually stung by a wasp which caused anaphylactic shock and caused him to fall in his driveway on concrete and hit face first. He broke his nose and fractured his front teeth, breaking one off in the process.
courtneydsnow Posted: Tuesday, July 20, 2021 3:31:37 PM(UTC)
 
Hi Tiffany!

D9248 - non-intravenous conscious sedation
For patients 5+ years old, can be cross coded to:
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)


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


D7210
- Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated
D4266 - guided tissue regeneration - resorbable barrier, per site
D4910 - periodontal maintenance

As for the CPT code for extractions, guided tissue regeneration & perio maintenance, there is actually not 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 use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures


Now, as for the ICD-10 (diagnosis) codes to use for these services, you will want a code to describe the trauma, and a code to describe the accident itself.

For fractured teeth, your coding options are:
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
G89.11 - Acute pain due to trauma

For the for code to describe the accident, if you can provide me with some details on what the accident was/how it happened, i'm happy to offer you some coding options.

Hope this helps!
Tiffany Posted: Wednesday, July 14, 2021 2:47:07 PM(UTC)
 
Hi Courtney!

I work at a Periodontal office and am filing a medical claim for a patient that fractured two teeth in the result of an accident/trauma. I'm trying to find the right coding options for him as we don't generally file medical.

The Dental coding for treatment is:
9248- Non-intravenous conscious sedation, D9248?
7210- Extraction #8 - Using code S02.5XXB (root was exposed after fracture)
7210- Extraction #9 - Using code S02.5XXA
7953- Bone Replacement for ridge aug # 8- I'm not sure which codes to use for these two? Future implant placement is hopeful.
7953- Bone replacement for ridge aug #9-
4266- Guided tissue generation #8- 41870 - Periodontal mucosal graft ?
4910- Periodontal maintenance.- D4910?

Could you give some guidance? Thanks so much!
courtneydsnow Posted: Wednesday, July 14, 2021 9:10:14 AM(UTC)
 
Hi Chana!

Here are some procedure coding options that I believe will be pertinent to your case:

Bone grafts:
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

Implants:
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more)


As for the CPT code for extractions, there is actually not 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 use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures


Your providers will definitely want to drive home the point of a functional impairment in order to your medical insurer to consider this case medical in nature instead of dental in nature.

I was able to locate Anthem BC medical policy titled "Mandibular/Maxillary (Orthognathic) Surgery", here is a link to it:
https://www.anthem.com/dam/medpolicies/abc/active/guidelines/gl_pw_d083869.html

This policy should be extremely helpful for your provider to provide the information the insurer will be looking for to meet medical necessity guidelines, likely specifically under the labels of "Dysphagia" and/or "Masticatory dysfunction or malocclusion".

I hope this helps!
Guest Posted: Friday, July 9, 2021 12:11:26 AM(UTC)
 
Hi Courtney!

I hope this message finds you well :)

I've been researching a ton in hopes of helping my oral surgeon and prosthodontist be able to code my medically necessary All 4 On implant surgery and implant creation and molding costs.

I have Multiple Autoimmune disease syndrome, Crohn's disease, Sjogren's Syndrome, and GERD that have caused me to have the oral health status of that of a 70-year-old and I'm only 38.

I've been getting fillings since the age of 6 due to the aggressiveness of my conditions, and as I've gotten older I've had to have very large and deep fillings placed in every tooth that I have remaining, or a root canal on many of them.

Currently, I'm having severe pain in 2 of my teeth that had root canals previously and are now broken with the gum line in between them inflamed. This issue with inflamed gums is also playing out all through my mouth and with all of my other remaining teeth with excessive bleeding as well.

Implants are necessary bc at this point I can't eat properly, and the only thing left to do for my remaining 23 teeth are extractions since my fillings are so huge and deep, and a majority already have root canals. Not to mention that with every major tooth procedure, I end up in the hospital with a Crohn's flare bc of the antibiotics and my digestive issues, or bc of the pain and stress associated with the procedures. So, getting All 4 On implants is actually preventing my health from deteriorating even further with each additional filling or root canal. Implants will handle all of my oral issues at once and provide me with a clean slate that is less likely to also endanger my health.

My treatment plan will include my oral surgeon who will handle all of the extractions and stud placement and a prosthodontist who will create and insert my temporary and permanent implants.

As you can imagine, I'm beyond frustrated with my oral situation as I've always attended the dentist and completed fillings and root canals as suggested, but now all of those fillings and root canals are too old and/or weak and need the next step of care in order to keep my health on par.

Is there any way you could guide me on the medical codes to use with my health insurance company Anthem Bluecross PPO, to have both my oral surgery or extraction of my remaining heavily damaged 23 teeth removed, and any implant preparations and fittings afterward?

Any guidance or help you can supply me with would be HUGELY appreciated, and ABSOLUTELY life-saving.
otherwise, I'm not sure that I can afford the implants even though they are clearly necessary for me to eat and function :(

Thanks SO much and please stay safe ;)

xo, Chana
courtneydsnow Posted: Friday, April 16, 2021 7:35:22 AM(UTC)
 
Hi Jodi!

Extractions actually not have a direct crosscode, 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 use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures

For a sinus lift:
21210 - Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)
**use modifier -52 for reduced services when bone is not obtained from patient

For implants:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3 or less)
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more)


Hope this helps!
courtneydsnow Posted: Friday, April 16, 2021 7:32:51 AM(UTC)
 
Hi Guest!

Yes this thread is still active.
Guest Posted: Thursday, April 15, 2021 10:00:38 AM(UTC)
 
Hi,

I am working tirelessly to get the cost of my mom's dental implants done via prior authorization to medical.

Is this thread still active to help me go through the dental codes and cross reference them to the ICD and CPT codes
Guest Posted: Friday, April 2, 2021 4:26:52 PM(UTC)
 
Hello,
I am a patient and looking to bill medical for my extractions and bone graft and sinus lift. I have gerd, Barrett’s esophagus and laryngopharyngitis reflux also. Which that effects my bone loss and why I now need graft and sinus lift. I will also need implant dentures after I heal. The placement for them. Please what codes are used to bill medical insurance.

Thank you
Jodi