Hi Chana! Here are some procedure coding options that I believe will be pertinent to your case: Bone grafts: 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 Implants: 21249 – Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more) As for the CPT code for extractions, there is actually not direct crosscode we are aware of, so you can either bill the “D” code on the medical claim (many insurers these days will process “D” codes when they are medically necessary services), or you can use the CPT code below and include a narrative report describing the procedure: 41899 – Unlisted procedure, dentoalveolar structures Your providers will definitely want to drive home the point of a functional impairment in order to your medical insurer to consider this case medical in nature instead of dental in nature. I was able to locate Anthem BC medical policy titled “Mandibular/Maxillary (Orthognathic) Surgery”, here is a link to it: This policy should be extremely helpful for your provider to provide the information the insurer will be looking for to meet medical necessity guidelines, likely specifically under the labels of “Dysphagia” and/or “Masticatory dysfunction or malocclusion”. I hope this helps!
