The term “TMJ” has an average of 201,000 searches a month. That’s over 2.4 million times per year! Other popular searches include “temporomandibular joint dysfunction,” which ranks at an average of 90,500 a month or over 1 million a year, and “TMJ treatment,” with 60,500 a month or over 700,000 searches per year. These numbers do not even include related searches like “jaw pain”, “TMJ headache”, “TMJ disorder”, and “TMJ specialist near me,” – to name a few other popular related searches. It is abundantly clear that patients seek help with this often painful and distressing condition.
Dental practices are at the forefront of offering these much-needed diagnosis & treatment services! The fantastic news is that many medical plans provide coverage for these services. The next bit of excellent news is that dental practices can successfully bill their patient’s medical insurance for these services with the proper clinical documentation and the correct medical codes.
So what codes are needed? The answer is medical ICD-10 (diagnosis) and CPT (procedure) codes. The ICD-10 diagnosis codes communicate the specific TMJ disorder and any accompanying symptoms. There are plenty of medical billing codes to identify common symptoms accompanying TMJ disorders such as head pain, facial pain, neck pain, and ringing of the ears to the medical insurer. TMJ disorder is called “the great imposter” due to the many other conditions it may mimic. The ICD-10 diagnosis coding system currently contains 16 codes for specific TMJ disorders. The specific TMJ disorder codes range from M26.611-M26.69. These diagnosis codes are grouped into five categories: articular disc disorder, arthralgia, arthritis, arthropathy, and adhesions & ankylosis. Each diagnosis code also requires the indication of left, right, or both sides (bilateral). An example is M26.633 which stands for “Articular disc disorder of bilateral temporomandibular joint”. Once you have selected the diagnosis code, the dental office can file CPT procedure codes indicating to the medical insurer what treatment services you render to a patient.
CPT codes commonly used by dental practices for TMJ disorder diagnosis & treatment services include office visit codes (evaluation and management (E&M) codes). Other medical CPT codes include x-rays, removable intra-oral appliances, and trigger point injections. An example is 20553, used for trigger point injections in 3 or more muscles.
The time to start billing medical insurance is now! With so much opportunity to help TMJ and headache patients receive necessary treatment, dental offices can help patients use their medical coverage. Nierman Practice Management is here to help dental practices grow TMJ treatment and orofacial pain services by offering the education and solutions to implement medical billing successfully.
Please feel free to contact us with any questions related to this article on TMJ disorders. We host CE courses on Medical Billing for Dentists and clinical treatment of TMD disorders and Dental Sleep Medicine. For more information, contact Nierman Practice Management at 1-800-879-6468 option 1, by sending us an email at firstname.lastname@example.org or by visiting niermanpm.com.
We have a variety of online and live courses for dentists, including topics such as, TMJ, craniofacial pain, dental sleep medicine, and medical billing in dentistry. We also have a comprehensive, online course series for medical billing in dentistry.
Article by: Courtney Snow and Rose Nierman