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Guest
#41 Posted : Monday, July 12, 2021 12:55:02 PM(UTC)
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My son is experiencing condylar resorption (Diagnosis M26.623). His condyle is disintegrating and likely eventually closing his airway. We are seeing a dentist who believes that Advanced Lightwire Functional (ALF) appliance will help to correct the deformities that caused the condylar resorption and open his airway. I have the following dental codes. Would someone be able to give me the medical codes so that we could try to get medical insurance to cover some of the costs? I was able to get some codes but cannot locate codes for these:

D0140 Detailed and extensive oral exam
D0290 anterior-posterior skull film
D0350 oral and facial photographs
D0470 diagnostic casts

Thanks so much for any help!

Jill
AC
#42 Posted : Tuesday, July 13, 2021 9:43:10 AM(UTC)
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Hi. Any help would be appreciated. My son had a soft tissue biopsy of the roof of his mouth by an oral surgeon. The excised tissue was sent to a lab that doesn't process dental insurance. The procedure code they gave me was:

D10.39 (I'm guessing ICD-10-CM)
Benign neoplasm of other parts of mouth

I am trying to submit this pathology report to my dental insurance but cannot find the appropriate billing code or a website that converts them.

The procedure code from the Oral Surgeon was
D7286
Incisional Biopsy of Oral Tissue - Soft

They submitted the tissue to a lab (unfortunately out of plan, in another state). According to my benefits, my insurance should still cover this at 100%, but no one will submit this for me. Not the doctor. Not the lab.

Please advise.

Thank you!

Edited by user Tuesday, July 13, 2021 9:46:30 AM(UTC)  | Reason: added information

courtneydsnow
#43 Posted : Tuesday, July 13, 2021 12:02:51 PM(UTC)
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Hi Jill!


D0140 - limited oral evaluation - problem focused
can be crosscoded to:
99202 - level 2 new patient Evaluation & Management (office visit)
or
99212 - level 2 established patient Evaluation & Management (office visit)


D0290
- this is actually not a valid code. Did you perhaps mean one of the following below?

D0220 - intraoral - periapical first radiographic image
D0230 - intraoral - periapical each additional radiographic image
D0240 - intraoral - occlusal radiographic image
D0250 - extra-oral – 2D projection radiographic image created using a stationary radiation source, and detector
D0270 - bitewing - single radiographic image


D0350
- 2D oral/facial photographic image obtained intra-orally or extra-orally
D0470 - diagnostic casts
can be crosscoded to:
99070 - special supplies & materials


Hope this helps!
courtneydsnow
#44 Posted : Tuesday, July 13, 2021 12:14:15 PM(UTC)
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Hi AC!

Sorry, did you mean that you are looking for the medical (CPT) code for this biopsy procedure? If so:

D7286 - incisional biopsy of oral tissue-soft

Here are some CPT cross coding options for you depending on the location in the oral cavity of the biopsy:

40490 - Biopsy lip
40808 - Biopsy, vestibule of mouth
41108 - Biopsy of floor of mouth
41110 - Biopsy of tongue, anterior two-thirds
41105 - Biopsy of tongue, posterior one-third
42100 - Biopsy of palate, uvula


Hope this helps!
Guest
#45 Posted : Tuesday, July 13, 2021 1:16:14 PM(UTC)
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Hi. I'm trying to submit this to my Dental Insurance, so I'm looking for the CDT code (not the medical codes), since they pay it at 100%. All I have is a diagnostic Code from the lab:
D10.39

I'm looking for the code for doing the pathology on the biopsy. Since these are 2 separate claims. The biopsy was conducted (and filed) by the oral surgeon, but the pathology is from an independent lab. The OS submitted their claim, but I have to submit the Lab claim myself.

I saw there were some pathology lab codes on my dental insurance's website.

perhaps it is D0473 Accession of tissue, gross and microscopic examination, preparation and transmission of written report

The lab billing department told me their procedure code was: 88342
I'm not sure if that is internal to their lab or an actual billing code.

-AC

Edited by user Tuesday, July 13, 2021 1:17:03 PM(UTC)  | Reason: name

courtneydsnow
#46 Posted : Wednesday, July 14, 2021 8:56:32 AM(UTC)
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Hi AC!

Ah ok - dental coding is not our forte here like medical coding is, but hopefully this information is helpful:

88342 is a medical CPT code, which stands for:
Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure

And here are some coding options from the oral pathology section of dental codes that may be applicable:

D0472 - accession of tissue, gross examination, preparation and transmission of written report
D0473 - accession of tissue, gross and microscopic examination, preparation and transmission of written report
D0474 - accession of tissue, gross and microscopic examination, including assessment of surgical margins for presence of disease, preparation and transmission of written report
D0476 - special stains for microorganisms
D0477 - special stains, not for microorganisms
D0478 - immunohistochemical stains
D0482 - direct immunofluorescence
D0483 - indirect immunofluorescence
D0502 - other oral pathology procedures, by report


Hope this helps!
Guest
#47 Posted : Thursday, July 15, 2021 9:53:53 AM(UTC)
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Thanks. I used:
D0473 - accession of tissue, gross and microscopic examination, preparation and transmission of written report

I hope I don't have to file again. If I do, I would probably go with D0502, but hopefully this will do.

I really appreciate your help. Patient's shouldn't be made to file their own claims w/procedure codes--this should be the responsibility of the treating doctor/dentist/etc.

-AC
Guest
#48 Posted : Wednesday, September 1, 2021 8:04:59 AM(UTC)
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Hi!

I desperately need help transferring a few dental codes to medical codes. Neither the dentist, periodontist, or insurance is willing to help me and I've had unbelievable dental costs due to an accident which left me in a coma and did significant dental damage. The codes I currently need are:

D6057
D6059

Thank you!
courtneydsnow
#49 Posted : Thursday, September 2, 2021 1:07:04 PM(UTC)
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Hi Guest!

D6057 - custom fabricated abutment – includes placement
D6059 - abutment supported porcelain fused to metal crown (high noble metal)

For both of these services listed above, there is actually not direct crosscodes we are aware of, so if the medical insurers cannot accept the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), you can use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures


Since it is a trauma case, you will want to be sure the ICD-10 (diagnosis) codes reflect that! If you can provide me some details about the accident (how it happened and what damage it caused), i am happy to offer you some coding options.


Hope this helps!
Guest
#50 Posted : Tuesday, September 7, 2021 10:45:19 AM(UTC)
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Thank you so much for your response! I feel bad but I have actually compiled my whole list of codes together to see if I could get help with a few more.

D 2999
D 6010
D 6057
D 6058
D 6104
D 7210
D 7921
D 7950


I slipped off a dock and hit a boat under my jaw before falling into the water unconscious. 2 of my teeth came out during the accident and 3 others were so damaged they needed to be removed (so 5 total gone from the accident). Please let me know if there are any other specifics you would need. I really appreciate your help.
courtneydsnow
#51 Posted : Wednesday, September 8, 2021 9:28:41 AM(UTC)
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Hi Guest!

Absolutely!

D6010 - surgical placement of implant body: endosteal implant
can be cross coded to:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3 or less)


D6104 - bone graft at time of implant placement
can be crosscoded to:
21210 - graft, bone; nasal, maxillary, or malar areas
21215 - graft, mandibular
**use modifier -52 for reduced services when bone is not obtained from patient


D7921
– collection and application of autologous blood concentrate product
can be crosscoded to:
0232T - Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed


D2999 - unspecified restorative procedure, by report
D6057 - custom fabricated abutment – includes placement
D7210 - Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated
D7950 - osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla - autogenous or nonautogenous, by report

The codes listed above do not have a 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
**special note - since D2999 stands for an "unspecified" restorative procedure, you will likely need to ask your provider for a short description of what service/procedure this code is being used to represent


As far as the diagnosis code(s) - based on what you described, here are some coding options (you may need to consult with your provider to select the most appropriate loss of teeth and fracture codes):

For the trauma to your teeth:
One of these:
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

One or both of these:
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture

And this one if applicable:
G89.11 - Acute pain due to trauma

To describe the accident, both of these:
W01.198A - Fall on same level from slipping, tripping and stumbling with subsequent striking against other object, initial encounter
W17.4XXA - Fall from dock, initial encounter


Hope this helps!
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