Hi! I hope you can help me with this. We have a patient that lost consciousness and fell face-forward onto concrete, resulting in several fractured teeth requiring removal. The teeth have already been extracted and the patient is now ready for implants. The patient”s medical insurance does have implant coverage as long as specific criteria are met, however, they also told me the exclusions for coverage included something along the lines of ”if it is due to trauma from a force outside of the mouth.” That says to me that they will not cover it for the result of a fall. The patent has spoken with the insurance company and said that since he fainted due to a medical reason/episode, they will cover it if we code it correctly. How can I code for this? The patient is wanting between 2-5 implants, depending on their coverage. THANK YOU for any insight you can provide!
