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#1 Posted : Monday, August 27, 2018 11:37:15 AM(UTC)

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My 20 year old son broke his jaw in 3 places(wired shut for 2 months) and messed up several teeth. We are having a hard time getting dental offices to bill medical because they say there are not dental codes for medical procedures and they will "file" for us but we must pay before any work begins. I took notes during the dental exam but I'm not sure what it all means.

#3 broke tooth and now has cavity
#4 fractured needs extracted
#5 needs crown
#6 chip - needs smoothing
#12 fractured/needs crown or extraction
#13 fractured/needs crown
#14 fractured
#15 needs filling
#19 crown lengthening
#26 ortho wire bonded to this tooth (detached from others)
#30 cusp fracture

3 front bottom teeth need root canals

My son has never had a cavity, he had his teeth cleaned May 10, 2018 and accident on May 20, 2018. His appointment with Prosthdontist this week will hopefully begin treatment as my son is in pain. Any ideas/codes/information would be greatly appreciated.

Thanks in advance!
#2 Posted : Tuesday, August 28, 2018 10:37:07 AM(UTC)

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Hi Guest!

No problem we are happy to help, I'm sorry your son is going through that. The dental practice will need to assign the appropriate ICD (diagnosis) code(s) for your son's case, as well as provide the appropriate procedure codes for the work done to the medical insurer.

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

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

As for how the accident happened - there is a code for that as well! If you would like to provide me some additional details about the accident (i.e. trip & fall, hit by baseball, punched in face, vehicle accident, etc) I would be happy to provide you some options for that.

As for the procedure codes, based on what you described, it sounds like most or all of the procedures will actually get billed to the medical insurer using the "D" (dental) codes. Extractions, crowns, fillings, smoothing, ortho & crown lengthening do have have a direct CPT crosscode, so 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!

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