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Hi Guest! Great question: K08.423 stands for: Partial loss of teeth due to periodontal diseases, class III K08.22 stands for: Moderate atrophy of the mandible For bone grafts and implants, simply loss of teeth due to perio disease and moderate atrophy alone won”t always do the trick to establish medical necessity. For example – is the patient experiencing pain or problems with mastication? If there is not something additional like that present, then many medical insurers would deem these procedures cosmetic, or dental in nature. Or for example, many trauma cases would see coverage as medically necessary. Hope this helps!
Hello . We billed to medicare for 21248 and 21215 (52). For 21248 we used K08.423. For 21215 we used K08.22. Claim was denied because they considered these ICD codes routine . what was wrong? Thank You
THANK YOU . So , what icd10 codes can we use that get paid..Patient cannot stand any removable prosthesis. And she needed bone graft for sure before implants . What codes Medicare would consider as medical necessity? Thank You /
Hi Guest! Great question. The diagnoses that establish medical necessity for bone grafts and implants do vary from insurer to insurer. However, some diagnoses/situations where we typically see coverage are items like: – Trauma/accidents – of course there are many different diagnostic codes available to represent different traumas and injuries, but a few common ones: K08.411 – Partial loss of teeth due to trauma, class I K08.412 – Partial loss of teeth due to trauma, class II K08.413 – Partial loss of teeth due to trauma, class III K08.414 – Partial loss of teeth due to trauma, class IV K08.419 – Partial loss of teeth due to trauma, unspecified class S02.5XXA – Fracture of tooth (traumatic), initial encounter for closed fracture S02.5XXB – Fracture of tooth (traumatic), initial encounter for open fracture – Tumors/cysts/abscess – again there are many, but here are a few examples: K12.2 – Cellulitis and abscess of mouth K04.6 – Periapical abscess with sinus K04.7 – Periapical abscess without sinus K09.0 – Developmental odontogenic cysts K09.1 – Developmental (nonodontogenic) cysts of oral region K09.8 – Other cysts of oral region, not elsewhere classified K04.8 – Radicular cyst C03.0 – Malignant neoplasm of upper gum C03.1 – Malignant neoplasm of lower gum C03.9 – Malignant neoplasm of gum, unspecified C04.0 – Malignant neoplasm of anterior floor of mouth C04.1 – Malignant neoplasm of lateral floor of mouth C04.8 – Malignant neoplasm of overlapping sites of floor of mouth C04.9 – Malignant neoplasm of floor of mouth, unspecified C05.0 – Malignant neoplasm of hard palate C05.1 – Malignant neoplasm of soft palate C05.8 – Malignant neoplasm of overlapping sites of palate C05.9 – Malignant neoplasm of palate, unspecified C06.1 – Malignant neoplasm of vestibule of mouth For Medicare specifically – their stance on dental services is that “Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw.” – here is a link to their statement: Hope this helps!
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