DentalWriter Forum

Your central resource for DentalWriter posts, blogs, training resources, faq's, and more.

Notification

Icon
Error

Post Reply
erinmcg14
#1 Posted : Monday, June 29, 2015 12:51:22 PM(UTC)
Quote
erinmcg14

Rank: New Member

Joined: 7/23/2013(UTC)
Posts: 3

Was thanked: 1 time(s) in 1 post(s)
is there a specific code medical or dental I use for a tongue stabilization device?? This is strictly for snoring... This will not be billed to medical however, I want all the proper documentation. Thanks in advance!!
courtneydsnow
#2 Posted : Monday, June 29, 2015 5:03:53 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,790

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi erinmcg14!

Great question! You have a few options for coding for the TSD/TRD, depending on what type of TRD it is :)

Basically, TRD's actually fit the description for HCPCS codes E0485 & E0486:

E0485 = Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment

E0486 = Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment

Another option:
E1399 - durable medical equipment, miscellaneous


For example, in Cigna's medical policy states:

“Cigna covers a tongue-retaining device or a mandibular repositioning appliance (HCPCS codes E0485, E0486, S8262)), also referred to as mandibular advancement appliance or mandibular advancement splint, as medically necessary for an individual with mild or moderate OSA when EITHER of the following criteria is met:

•apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) ≥ 15 and < 30*, as documented by polysomnography (PSG) or home/portable sleep study

•AHI or RDI ≥ 5 and < 15*as documented by PSG or home/portable sleep study, when accompanied by symptoms of OSA (e.g., excessive daytime sleepiness, impaired cognition, mood disorders or insomnia) or when individual has hypertension, ischemic heart disease or history of stroke”



Here is a link to the full policy if you are interested:
https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0158_coveragepositioncriteria_obstructive_sleep_apnea_diag_trtment_svc.pdf


So if the TRD is being used to treat snoring only, there will not likely be much coverage......most medical policies do not show treatment of snoring as a medically necessary service....yet! I am sure it will one day.....it's getting there :)

Hope this helps, please let us know if yuu have any further questions!
erinmcg14
#3 Posted : Tuesday, June 30, 2015 7:07:51 AM(UTC)
Quote
erinmcg14

Rank: New Member

Joined: 7/23/2013(UTC)
Posts: 3

Was thanked: 1 time(s) in 1 post(s)
I thought so... thanks so much for the clarification!!
Seguros Enterate
#4 Posted : Thursday, November 17, 2022 11:29:13 PM(UTC)
Rank: Guest


Was thanked: 16 time(s) in 15 post(s)
Message was deleted by a Moderator. | Reason: Not specified
Seguro Medico Ahora
#5 Posted : Friday, November 18, 2022 1:28:18 AM(UTC)
Rank: Guest


Was thanked: 16 time(s) in 15 post(s)
Message was deleted by a Moderator. | Reason: Not specified
Quick Reply Show Quick Reply
Post Reply
Forum Jump  
You cannot 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.