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Guest
#1 Posted : Thursday, May 31, 2018 9:49:27 AM(UTC)
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Guest

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Wondering if anyone would know the best diagnosis code for a patient who was assaulted and lost multiple teeth. I know very little about medical codes but thinking K08.419. I am submitting the following dental codes:

D0140
D4321
D0220
D0230
D0330
D5820

It is a Medicare policy with Humana. I have spent hours on the phone and resubmitting as they instruct only to be denied over and over.

Thank you!!
courtneydsnow
#2 Posted : Monday, June 4, 2018 11:35:21 AM(UTC)
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courtneydsnow

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Hi Guest!

Starting off the diagnosis code(s). K08.419 - Partial loss of teeth due to trauma, unspecified class.
That does sound like an appropriate option based on what you described. However, if you can use one of the following below instead, medical insurers always prefer more specific codes when possible:

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

Here are some additional options if there was other damage as well:

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
K08.531 - Fractured dental restorative material with loss of material
K08.530 - Fractured dental restorative material without loss of material

You will also want to use coding to described the situation of assault. There are many different assault codes available depending on how the person was assaulted (fist fights, guns, knives, blunt objects, etc etc etc) - so if you could provide more detail surrounding that I would be happy to offer you some coding options :)


Now, as for the procedure codes you listed - some of them do have direct crosscodes over to CPT codes, some do not. That info is below:

D0140 - limited oral evaluation - problem focused
Can be crosscoded to:
99201 - Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
or
99211 - Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.


D0220 - intraoral - periapical first radiographic image
can be cross coded to:
70300 - Radiologic examination, teeth; single view


D0230
- intraoral - periapical each additional radiographic image
Can be cross coded to:
70310 - Radiologic examination, teeth; partial examination, less than full mouth


D0330 - panoramic radiographic image
Can be cross coded to:
70355 - Orthopantogram (eg, panoramic x-ray)



D4321 - provisional splinting - extracoronal
D5820 - interim partial denture (maxillary)

The codes listed above do not have direct crosscodes 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

Hope this helps!

Guest
#3 Posted : Tuesday, February 23, 2021 9:58:22 AM(UTC)
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I work for an Endodontist. I have a patient that was in an Automobile accident that caused trauma to #7, which needed Root Canal Treatment from our office. I am having trouble with the Medical insurance company paying on the claim. They keep denying the claim. They have stated that they need both the Medical procedure code and Diagnostic code.
What are the Correct Medical Procedure and Diagnostic Codes for the following:

D0140-Limited Oral Evaluation- Problem Focus
D0220-Intraoral-PA-First Film
D3310-Anterior Root Canal Therapy

Thank you for any advice.
courtneydsnow
#4 Posted : Tuesday, February 23, 2021 12:59:31 PM(UTC)
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courtneydsnow

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Hi Guest!

Great question. Let's start with the procedure codes:

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)


D0220 - intraoral - periapical first radiographic image
can be cross coded to:
70300 - Radiologic examination, teeth; single view


D3310 - Endodontic therapy anterior tooth (excluding final restoration)


The code 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


Now, as for the diagnosis code(s). I'll need a little more information on how the automobile accident happened in order to offer you the best coding options...accident diagnosis codes get very specific on that! For example, was the patient the driver or passenger? What type of vehicle were they in? (car, pickup truck, ATV, etc). Also, was this a traffic accident, or did they hit a stationary object or animal, etc?

The primary diagnosis(es) should be the trauma to the teeth - for example:

Traumatic fracture of tooth:
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
S02.5XXD – Fracture of tooth (traumatic), subsequent encounter for fracture with routine healing
S02.5XXG - Fracture of tooth (traumatic), subsequent encounter for fracture with delayed healing
S02.5XXK - Fracture of tooth (traumatic), subsequent encounter for fracture with nonunion
S03.2XXA - Dislocation of tooth, initial encounter
S03.2XXD - Dislocation of tooth, subsequent encounter


Hope this helps!
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