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Hello, we attended the course last saturday at VA. We”re still trying to figure things out. We need to submit med claim for CT Scan (D0364) and Surgical guide (D6190). Please help! What diagnosis code we need to use? Thank you! Susan
Hi Courtney, Thank you so much for helping us on this matter! We performed Extraction, graft and added tissue to the area due to fractured and abscessed mandible tooth #19. So we need to take CT Scan and surgical guide for implant placement. Again, thank you! Susan
Hi Susan! Great question. The diagnosis code(s) used will depend on the patients condition. Basically, the diagnosis code will be the reason the CT scan and surgical guide are being performed. For example, if the CBCT was performed due to a malignant neoplasm of the mandible, you may use: C41.1 – Malignant neoplasm of mandible If you”d like to give me some details about this specific case, I would be happy to offer you some coding options.
Hi Susan! My pleasure. So, as far as the diagnosis code for the fractured mandible – do you have any info on the specific area of the fracture available? Reason I ask is there are tons of different fracture of mandible codes available (and also whether it is an open or closed fracture, and whether right or left) such as: S02.600A – Fracture of unspecified part of body of mandible, unspecified side, initial encounter for closed fracture S02.600B – Fracture of unspecified part of body of mandible, unspecified side, initial encounter for open fracture S02.601A – Fracture of unspecified part of body of right mandible, initial encounter for closed fracture S02.601B – Fracture of unspecified part of body of right mandible, initial encounter for open fracture S02.602A – Fracture of unspecified part of body of left mandible, initial encounter for closed fracture S02.602B – Fracture of unspecified part of body of left mandible, initial encounter for open fracture S02.609A – Fracture of mandible, unspecified, initial encounter for closed fracture S02.609B – Fracture of mandible, unspecified, initial encounter for open fracture S02.610A – Fracture of condylar process of mandible, unspecified side, initial encounter for closed fracture S02.610B – Fracture of condylar process of mandible, unspecified side, initial encounter for open fracture S02.611A – Fracture of condylar process of right mandible, initial encounter for closed fracture S02.611B – Fracture of condylar process of right mandible, initial encounter for open fracture S02.612A – Fracture of condylar process of left mandible, initial encounter for closed fracture S02.612B – Fracture of condylar process of left mandible, initial encounter for open fracture S02.620A – Fracture of subcondylar process of mandible, unspecified side, initial encounter for closed fracture S02.620B – Fracture of subcondylar process of mandible, unspecified side, initial encounter for open fracture ….and so on and so forth 🙂 As for the abscess, you may consider using: M27.2 – Inflammatory conditions of jaws As for the tooth – you may consider using: K12.2 – Cellulitis and abscess of mouth K03.81 – Cracked tooth (or something else, depending on what is appropriate to describe the issue with tooth #19).
Great!Thank you Courtney. How about the D9940, how do you code them for bruxism, muscle spasm, joint pain and excessive wear of teeth due to grinding?
Hi Susan! Here are some coding options for you: Bruxism: F45.8 – Other somatoform disorders G47.63 – Sleep related bruxism Muscle Spasm: M62.838 – Other muscle spasm Joint pain (i am assuming you are referring to temporomandibular joint pain?): M26.601 Right temporomandibular joint disorder, unspecified M26.602 Left temporomandibular joint disorder, unspecified M26.603 Bilateral temporomandibular joint disorder, unspecified M26.609 Unspecified temporomandibular joint disorder, unspecified side M26.611 Adhesions and ankylosis of right temporomandibular joint M26.612 Adhesions and ankylosis of left temporomandibular joint M26.613 Adhesions and ankylosis of bilateral temporomandibular joint M26.619 Adhesions and ankylosis of temporomandibular joint, unspecified side M26.621 Arthralgia of right temporomandibular joint M26.622 Arthralgia of left temporomandibular joint M26.623 Arthralgia of bilateral temporomandibular joint M26.629 Arthralgia of temporomandibular joint, unspecified side M26.631 Articular disc disorder of right temporomandibular joint M26.632 Articular disc disorder of left temporomandibular joint M26.633 Articular disc disorder of bilateral temporomandibular joint M26.639 Articular disc disorder of temporomandibular joint, unspecified side M26.69 – Other specified disorders of temporomandibular joint Excessive wear of teeth due to grinding: K03.0 – Excessive attrition of teeth K03.1 – Abrasion of teeth Hope this helps!
Hi Susan! D9940 – occlusal guard, by report There is not a specific crosscode for D9940. If you are using this code to represent an appliance being used to treat TMD: What we are finding is that the code that is most commonly accepted by medical insurers currently for TMD appliances since the S8262 discontinuation June 2015 is D7880 – occlusal orthotic device, by report. However, some insurers are accepting the other codes listed below as well: D7899 – unspecified TMD therapy, by report Or, if the medical insurer says they won’t process the “D” codes (most will these days, but you will run into a few that won’t), you can try: E1399 – Durable medical equipment, miscellaneous 21299 – Unlisted craniofacial and maxillofacial procedure 21499 – Unlisted musculoskeletal procedure, head A narrative report explaining the treatment accompanying the claim is recommended since they are all “by report”, “unlisted”, or “miscellaneous” codes. For example, Aetna”s medical policy for Temporomandibular disorders lists D7880 as an accepted HCPCS code is criteria is met: Hope this helps!
Thank you so much Courtney! Do you have the sample letter ppre-auth for Graft/implant placement/occlusal guard?
Good morning, Could you please help finding diagnosis codes and CPT codes for surgical guide D6190 and CT scan D0367 prior to placing implant # 26. Pt presented to our office with having tooth extracted prior to coming to our office. He is proceeding with implant placement # 26. Thank you very much. Warmly, Tracey Howard RDH
Hi Guest! As for the CPT code for surgical guide, there is not a 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 codes below and include a narrative report describing the procedure: 41899 – Unlisted procedure, dentoalveolar structures For for the Cone Beam CT: there is actually not currently a specific CPT code for CBCT……the closest CPT code is: “70486 – Computed tomography, maxillofacial area; without contrast material”. Many offices have been using this for some time for CBCT, however, some medical insurers are auditing that code when used for CBCT because the description does not specify “cone beam”. So, “76497 – Unlisted computed tomography procedure (eg, diagnostic, interventional)” is an option to use (keep in mind you”ll need to provide a narrative description for unlisted codes) We also see practices billing out for “76102 – Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography), other than with urography; bilateral” or, there are some medical insurers that will process the “D” codes for procedures when there is not a specific CPT code available. For example, here are the “D” codes from HealthPartner’s medical policy for “Cone-beam computed tomography (CT) scan for medically-related dental services” D0363 – Cone-Beam 3D multi image reconstruction D0364 – Cone beam CT capture and interpretation with limited field of view – less than one whole jaw D0365 – Cone beam CT capture and interpretation with field of view of one full dental arc – mandible D0366 – Cone beam CT capture and interpretation with field of view of one full dental arch – maxilla, with or without cranium D0367 – Cone beam CT capture with interpretation with field of view of both jaws, with or without cranium D0368 – Cone beam CT capture and interpretation for TMJ series including two or more exposures D0380 – Cone beam CT image capture with limited field of view – less than one whole jaw D0381 – Cone beam CT image capture with field of view of one full dental arch – mandible D0382 – Cone beam CT image capture with field of view of one full dental arch – maxilla, with or without cranium D0383 – Cone beam CT image capture with field of view of both jaws, with or without cranium D0384 – Cone beam CT image capture for TMJ series including two or more exposures Here is a link to the full policy: Hope this helps!
Patient requires implant in right maxillary posterior. Panoramic image indicates pneumatized right maxillary sinus and may indicate need for sinus lift. What is the ICD 10 diagnosis code to use in order to take a Cone Beam CT image to further diagnosis the sinus? Can you email the answer to frontdesk@drdanmeader.com
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