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Stonegate
#1 Posted : Wednesday, June 28, 2017 3:05:57 PM(UTC)
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Stonegate

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We have a Medicare patient who needs to have his tooth extracted prior to having radiation treatment to his mandible. What procedure code should be used to bill Medicare for the tooth extraction and what diagnosis code should be used for this?
Connie
courtneydsnow
#2 Posted : Thursday, June 29, 2017 9:20:33 AM(UTC)
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courtneydsnow

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Hi Connie!

For the extraction, there is actually not a specific CPT code for a tooth extraction so you will use the "D" code for that.

As for the diagnosis code to use, this will depend on the reason the tooth need to be extracted. For example, you may use of the following:

K02.3 - Arrested dental caries
K02.51 - Dental caries on pit and fissure surface limited to enamel
K02.52 - Dental caries on pit and fissure surface penetrating into dentin
K02.53 - Dental caries on pit and fissure surface penetrating into pulp
K02.61 - Dental caries on smooth surface limited to enamel
K02.62 - Dental caries on smooth surface penetrating into dentin
K02.63 - Dental caries on smooth surface penetrating into pulp
K02.7 - Dental root caries
K02.9 - Dental caries, unspecified

If the extraction is being done for another reason, let me know and I am happy to provide you with some coding options.

You may also consider using:
C41.1 - Malignant neoplasm of mandible

Hope this helps!


Guest
#3 Posted : Thursday, June 29, 2017 9:24:38 AM(UTC)
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Thank you for the information. Will Medicare recognize D7210?
courtneydsnow
#4 Posted : Friday, June 30, 2017 8:35:14 AM(UTC)
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courtneydsnow

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Hi guest!

That may be dependent on your Medicare Part B MAC for your region. If it is not recognized, you may use the following code: 41899 - Unlisted procedure, dentoalveolar structures

If you would like to tell me what state you're in, I would be happy to check out your Medicare Part B MAC's fee schedule to see if the D code is listed or not.
Guest
#5 Posted : Wednesday, November 14, 2018 5:07:37 PM(UTC)
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Hello. I am a program director in Michigan treating special needs adults for dental care and oral disease in the operating room. They are outpatient cases. What is the correct cpt medical code for the facility and anesthesi. The dental codes are typically paid by the medicaid, but the hospital fees are the issue.
Guest
#6 Posted : Thursday, February 18, 2021 1:26:54 PM(UTC)
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00170 and 41899
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