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Kay
#1 Posted : Monday, April 26, 2021 5:01:33 PM(UTC)
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Hi there,

I need help. I'm trying to bill medical insurance for a patient with accidental dental coverage. Includes D7210, D7953 and D5130. What should I put in box 21 of 1500 form? I put v89.2xxa because the patient but it's incorrect. Please help.
What Diagnosis and procedure codes should I use? Please help me . Thank you!
courtneydsnow
#2 Posted : Tuesday, April 27, 2021 10:02:14 AM(UTC)
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courtneydsnow

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Hi Kay!

Based on what you described, it sounds like the insurer may be looking for a trauma related diagnosis (ICD-10) code or codes!
The diagnosis code you listed is a valid one:
V89.2XXA - Person injured in unspecified motor-vehicle accident, traffic, initial encounter
(although there are more specific codes available to describe motor-vehicle accidents - if you can tell me if the patient was the driver or a passenger, and what type of vehicles were involved in the accident i can provide you some more specific coding options).

However the "how the accident happened" type codes should be listed last, and the trauma/injury codes first.

For example, here are some common trauma related diagnosis codes:
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

If these don't fit the bill for your patient, if you'd like to provide some additional details about the trauma/injury I am happy to provide from coding options.

Hope this helps!
Guest
#3 Posted : Friday, April 30, 2021 11:28:23 AM(UTC)
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Hi Courtney,

Thank you for responding.

The patient was on her bicycle and she was avoiding a car backing up. That's how she fell on her face. We extracted all 6 teeth on maxilla (w/ bone graft) which left her edentulous and needing a complete maxillary denture.

The procedures we did are 6 surgical extractions, bone graft on all 6 areas and complete maxillary denture. Please advise.

Looking forward to your response. Thank you so much!

Kay

Edited by user Tuesday, May 4, 2021 2:07:50 PM(UTC)  | Reason: Incorrect desription

courtneydsnow
#4 Posted : Tuesday, May 4, 2021 9:01:49 AM(UTC)
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courtneydsnow

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Hi Kay!

My pleasure.

Thanks for the additional details! Let's start with the diagnosis codes.

Be sure to code to the trauma/injury first, i.e. any of these diagnosis codes that apply:
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
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

Then, you'll want the diagnosis code(s) describing how the accident happened. For this situation, here's some options for you:
V18.0XXA - Pedal cycle driver injured in noncollision transport accident in nontraffic accident, initial encounter
V18.4XXA - Pedal cycle driver injured in noncollision transport accident in traffic accident, initial encounter

(if the bicycle collided with the car, let me know because there are different codes for "collision" situations)



Now on to the procedure codes:

There is actually not direct crosscodes for extractions & partials, 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 the 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


Hope this helps!
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