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Hi, I am a patient of a dentist. I was seen for the extraction of three upper molars. Pathology resulted in the erosion and perforation of the sinus floor bilaterally resulting in extensive mucositis/sinusitis/infection. Removal of the infected teeth resulted in sinus perforation on both sides. To avoid a prolonged infection and more rapid healing the dentist performed a socket graft/oral-astral closure. The procedure was coded to D7921 collection and application of blood and to D7953 bone replacement graft for the dentist”s billing purposes. These codes are not a benefit for my dental insurance and do not work medical billing. I have submitted a claim to Medicare and they are asking for ICD.9 or ICD.10 diagnosis codes. Do you have any suggestions for a code for medical insurance reimbursement purposes? Thank you for any suggestions you have Joe
Hi, I am a patient that had an implant procedure approx. 5 years ago. However in October 2018 with xray It was found that the bone around the implant deteriorating thus I needed to have this re done. As a result my dental insurance see the new bone grafting as a medical procedure but the dentist that completed the procedure does not know what diagnosis code to use can you help us. The procedure code he used was D7953 Thank you, Leslie
Hi Leslie! Based on what you described, here are some possible diagnosis coding options: K08.21 – Minimal atrophy of the mandible K08.22 – Moderate atrophy of the mandible K08.23 – Severe atrophy of the mandible K08.24 – Minimal atrophy of maxilla K08.25 – Moderate atrophy of the maxilla K08.26 – Severe atrophy of the maxilla M27.61 – Osseointegration failure of dental implant M27.62 – Post-osseointegration biological failure of dental implant M27.63 – Post-osseointegration mechanical failure of dental implant M27.69 – Other endosseous dental implant failure Also, for the procedure coding: D7953 – bone replacement graft for ridge preservation – per site Can be cross coded to: 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 Hope this helps!
Hi Joe! Based on what you described below, here are some ICD-10 coding options for the condition: J34.89 – Other specified disorders of nose and nasal sinuses J34.81 – Nasal mucositis (ulcerative) K12.39 – Other oral mucositis (ulcerative) J01.00 – Acute maxillary sinusitis, unspecified J01.01 – Acute recurrent maxillary sinusitis J01.10 – Acute frontal sinusitis, unspecified J01.11 – Acute recurrent frontal sinusitis J01.20 – Acute ethmoidal sinusitis, unspecified J01.21 – Acute recurrent ethmoidal sinusitis J01.30 – Acute sphenoidal sinusitis, unspecified J01.31 – Acute recurrent sphenoidal sinusitis J32.0 – Chronic maxillary sinusitis J32.1 – Chronic frontal sinusitis J32.2 – Chronic ethmoidal sinusitis J32.3 – Chronic sphenoidal sinusitis J32.4 – Chronic pansinusitis J32.8 – Other chronic sinusitis J32.9 – Chronic sinusitis, unspecified Hope this helps!
Hello, I am a patient and looking to bill medical for my extractions and bone graft and sinus lift. I have gerd, Barrett’s esophagus and laryngopharyngitis reflux also. Which that effects my bone loss and why I now need graft and sinus lift. I will also need implant dentures after I heal. The placement for them. Please what codes are used to bill medical insurance. Thank you Jodi
Hi Courtney! I hope this message finds you well 🙂 I”ve been researching a ton in hopes of helping my oral surgeon and prosthodontist be able to code my medically necessary All 4 On implant surgery and implant creation and molding costs. I have Multiple Autoimmune disease syndrome, Crohn”s disease, Sjogren”s Syndrome, and GERD that have caused me to have the oral health status of that of a 70-year-old and I”m only 38. I”ve been getting fillings since the age of 6 due to the aggressiveness of my conditions, and as I”ve gotten older I”ve had to have very large and deep fillings placed in every tooth that I have remaining, or a root canal on many of them. Currently, I”m having severe pain in 2 of my teeth that had root canals previously and are now broken with the gum line in between them inflamed. This issue with inflamed gums is also playing out all through my mouth and with all of my other remaining teeth with excessive bleeding as well. Implants are necessary bc at this point I can”t eat properly, and the only thing left to do for my remaining 23 teeth are extractions since my fillings are so huge and deep, and a majority already have root canals. Not to mention that with every major tooth procedure, I end up in the hospital with a Crohn”s flare bc of the antibiotics and my digestive issues, or bc of the pain and stress associated with the procedures. So, getting All 4 On implants is actually preventing my health from deteriorating even further with each additional filling or root canal. Implants will handle all of my oral issues at once and provide me with a clean slate that is less likely to also endanger my health. My treatment plan will include my oral surgeon who will handle all of the extractions and stud placement and a prosthodontist who will create and insert my temporary and permanent implants. As you can imagine, I”m beyond frustrated with my oral situation as I”ve always attended the dentist and completed fillings and root canals as suggested, but now all of those fillings and root canals are too old and/or weak and need the next step of care in order to keep my health on par. Is there any way you could guide me on the medical codes to use with my health insurance company Anthem Bluecross PPO, to have both my oral surgery or extraction of my remaining heavily damaged 23 teeth removed, and any implant preparations and fittings afterward? Any guidance or help you can supply me with would be HUGELY appreciated, and ABSOLUTELY life-saving. otherwise, I”m not sure that I can afford the implants even though they are clearly necessary for me to eat and function 🙁 Thanks SO much and please stay safe 😉 xo, Chana
BCBS wants my ICD-10 Code along with the procedure code The ICD-10 code is KO8.21 I was given a procedure code of 21215. Can you define that procedure fo me?
Hi Guest! 21215 – Graft, bone; mandible (includes obtaining graft) **use modifier -52 for reduced services when bone is not obtained from patient And just a quick note on the ICD code you listed, K08.21 (Minimal atrophy of the mandible) The second character should be a number “0” instead of the letter “O”. Hope this helps!
Hello, I have an accident where i required dental implants. I had the procedure done at my dental office, however, they could not bill my medical insurance because they did not have the correct codes & i had to pay almost 25k up front to get the surgery done. These were the codes i was provided, anything with a *, i believe this could be billed to my medical. How can i convert these codes to medical? *D6010 *D7210 *D7953 D4266 D6057 D2740 D2950 D9944 Thanks in advance!
Hi Guest! As for the CPT crosscodes for the procedures you listed: D6104 – bone graft at time of implant placement can be crosscoded to: 21210 – graft, bone; nasal, maxillary, or malar areas 21215 – graft, mandibular **use modifier -52 for reduced services when bone is not obtained from patient D6010 – surgical placement of implant body: endosteal implant can be cross coded to: 21248 – Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial (3 or less) (basically, if it was 3 or less implants, you”ll use 21248 instead of 21249) D0367 – Cone beam CT capture with interpretation with field of view of both jaws, with or without cranium 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, and some insurers require this code to be used for CBCT (i.e. UHC). 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). D0160 – detailed and extensive oral evaluation – problem focused, by report can be crosscoded to one of the following Evaluation & Management (E&M) codes: New patients: 99202 – 15-29 mins 99203 – 30-44 mins 99204 – 45-59 mins 99205 – 60-74 mins Established patients: 99212 – 10-19 mins 99213 – 20-29 mins 99214 – 30-39 mins 99215 – 40-54 mins D7210 – Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated D6085 – provisional implant crown D6051 – interim abutment As for extractions, crowns & abutments, they do not have a direct crosscode, 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 As for the ICD-10 diagnosis code(s), based on what you described, here are some coding options for you to consider: K03.81 – Cracked tooth Y65.8 – Other specified misadventures during surgical and medical care
Good morning, I have a patient that had a D7953 along with D7957 the day of the extraction to preserve to bone level for implant placement after healing. My question is that her insurance is denying due to stating it”s medical and needs to be submitted that way. I had the medical insurance agent call and asked if we can convert the codes to CPT? I”m thinking we give her the CDT codes we used, along with the diagnosis codes to go along with them to submit? Looking at the past responses, we know what diagnosis code would be for D7953, but what options do I have for D7957? Thank you, rachel
Hi Rachel! Depending on the patient”s condition/situation, it is very likely that you”ll use the same diagnostic codes for the D7957 as you did for the D7953 (basically, the diagnosis(es) that led to the bone graft being needed can be the same reason that the guided tissue regeneration needed to be done as well). And just a heads up, some medical insurers will require the use of CPT codes (medical procedure codes) instead of the CDT code (dental procedure codes). If that”s the case: D7953 – bone replacement graft for ridge preservation – per site Can be cross coded to: 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 D7957 – guided tissue regeneration, edentulous area – non-resorbable barrier, per site This code does not have 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), but for the medical insurers who won”t accept the “D” codes, you can try the CPT code below and include a narrative report describing the procedure: 41899 – Unlisted procedure, dentoalveolar structures Hope this helps!
Hi Guest! As for the CPT crosscodes for the procedures you listed: D6104 – bone graft at time of implant placement can be crosscoded to: 21210 – graft, bone; nasal, maxillary, or malar areas 21215 – graft, mandibular **use modifier -52 for reduced services when bone is not obtained from patient D6010 – surgical placement of implant body: endosteal implant can be cross coded to: 21248 – Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial (3 or less) (basically, if it was 3 or less implants, you”ll use 21248 instead of 21249) D0367 – Cone beam CT capture with interpretation with field of view of both jaws, with or without cranium 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, and some insurers require this code to be used for CBCT (i.e. UHC). 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). D0160 – detailed and extensive oral evaluation – problem focused, by report can be crosscoded to one of the following Evaluation & Management (E&M) codes: New patients: 99202 – 15-29 mins 99203 – 30-44 mins 99204 – 45-59 mins 99205 – 60-74 mins Established patients: 99212 – 10-19 mins 99213 – 20-29 mins 99214 – 30-39 mins 99215 – 40-54 mins D7210 – Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated D6085 – provisional implant crown D6051 – interim abutment As for extractions, crowns & abutments, they do not have a direct crosscode, 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 As for the ICD-10 diagnosis code(s), based on what you described, here are some coding options for you to consider: K03.81 – Cracked tooth Y65.8 – Other specified misadventures during surgical and medical care
Hello! Patient had (2) implants on #7 & 10. Procedure codes: D6104 D6010 D7210 D6085 D6051 D0367 D0160 Attempting to submit to medical, need ICD10. Backstory: Patient had ho pain/issue, xray detected fracture at root #7. Patient sent to Perio, new xray detected additional fracture also at root #10. No accident/injury, patient believes biting on xray plate may have cause damage? Any advice?
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