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Guest
#1 Posted : Tuesday, June 29, 2021 9:46:08 AM(UTC)
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Guest

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A pt is trying to see if she has coverage thru her medical insurance for D7953 bone for ridge preservation and D4266 Guided Tissue membrane. I used to have a cross coding book but do not have it with me at my office. Any ideas? Please and thanks.
courtneydsnow
#2 Posted : Friday, July 2, 2021 9:14:21 AM(UTC)
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courtneydsnow

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Hi Guest!

Whether or not the medical policy will cover these types of services depends on 2 main things: the patient's condition/diagnosis, and the coverage criteria set by the medical insurer.

For example, we commonly see bone grafts covered if they services are needed due to a accidental injury/trauma, removal of lesions/tumors, or functional impairment.
The coverage criteria can vary from insurer to insurer of course. For example, here is a link to BCBS of NC's medical policy titled "Dental Reconstructive Services": https://www.bluecrossnc.com/sites/default/files/document/attachment/services/public/pdfs/medicalpolicy/dental_reconstructive_services.pdf

As for the coding:


D7953
- bone replacement graft for ridge preservation - per site
Can be cross coded to:
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


D4266
- guided tissue regeneration - resorbable barrier, per site

There is not a direct crosscode available for this service, so if the medical insurer will not accept the "D" code on the medical claim (many will these days when they are medically necessary procedures), or you can use the code below and include narrative report to describe the procedure:
41899 - Unlisted procedure, dentoalveolar structures


Hope this helps!
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