DentalWriter Forum

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

Notification

Icon
Error

New Topic Post Reply
Guest
#1 Posted : Tuesday, June 29, 2021 9:46:08 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,234

Was thanked: 16 time(s) in 15 post(s)
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)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,732

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
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!
Guest
#3 Posted : Monday, August 21, 2023 7:33:36 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,234

Was thanked: 16 time(s) in 15 post(s)
Need cross coding for D9239 and D9243 pls. Thank you!
Guest
#4 Posted : Monday, August 21, 2023 7:37:07 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,234

Was thanked: 16 time(s) in 15 post(s)
Need cross coding for D9239 and D9243 pls. Thank you!
Quick Reply Show Quick Reply
New Topic Post Reply
Forum Jump  
You can 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.