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Hi Tiffany! Ok great thanks for those details! Based on what you described, it looks like you best option to describe the fall is: W18.39XA – Other fall on same level, initial encounter Hope this helps!
Thank you so much Courtney! The patient was actually stung by a wasp which caused anaphylactic shock and caused him to fall in his driveway on concrete and hit face first. He broke his nose and fractured his front teeth, breaking one off in the process.
Hi Tiffany! D9248 – non-intravenous conscious sedation For patients 5+ years old, can be cross coded to: 99152 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older 99153 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; each additional 15 minutes intraservice time (list separately in addition to code for primary service) 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 D7210 – Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated D4266 – guided tissue regeneration – resorbable barrier, per site D4910 – periodontal maintenance As for the CPT code for extractions, guided tissue regeneration & perio maintenance, 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 Now, as for the ICD-10 (diagnosis) codes to use for these services, you will want a code to describe the trauma, and a code to describe the accident itself. For fractured teeth, your coding options are: S02.5XXA – Fracture of tooth (traumatic), initial encounter for closed fracture S02.5XXB – Fracture of tooth (traumatic), initial encounter for open fracture S03.2XXA – Dislocation of tooth, initial encounter G89.11 – Acute pain due to trauma For the for code to describe the accident, if you can provide me with some details on what the accident was/how it happened, i”m happy to offer you some coding options. Hope this helps!
Hi Courtney! I work at a Periodontal office and am filing a medical claim for a patient that fractured two teeth in the result of an accident/trauma. I”m trying to find the right coding options for him as we don”t generally file medical. The Dental coding for treatment is: 9248- Non-intravenous conscious sedation, D9248? 7210- Extraction #8 – Using code S02.5XXB (root was exposed after fracture) 7210- Extraction #9 – Using code S02.5XXA 7953- Bone Replacement for ridge aug # 8- I”m not sure which codes to use for these two? Future implant placement is hopeful. 7953- Bone replacement for ridge aug #9- 4266- Guided tissue generation #8- 41870 – Periodontal mucosal graft ? 4910- Periodontal maintenance.- D4910? Could you give some guidance? Thanks so much!
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!
Hi Jodi! Extractions actually 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 For a sinus lift: 21210 – Graft, bone; nasal, maxillary or malar areas (includes obtaining graft) **use modifier -52 for reduced services when bone is not obtained from patient For implants: 21248 – Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3 or less) 21249 – Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more) Hope this helps!
Hi, I am working tirelessly to get the cost of my mom”s dental implants done via prior authorization to medical. Is this thread still active to help me go through the dental codes and cross reference them to the ICD and CPT codes
Hi Guest! Great question. Whether or not the patient will be eligible for medical coverage/reimbursement for the services you listed will all depend on the “why” basically! Your patient”s condition/diagnosis will determine if the medical insurer considers those services medically necessary or not. For example, it is not typical for a medical insurer to offer coverage for a single implant, however if it is needed due to a traumatic accident or tumor removal, it can be covered! Same with the services you listed – it”s not extremely common for a medical insurer to cover just a plain night guard/occlusal guard, however if the patient is diagnosed with TMJD and the appliance is being used to treatment, many medical insurers offer coverage for that. Or, if it is an appliance being used to treat Obstructive Sleep Apnea, most medical insurers do offer coverage. We have wonderful crosscoding seminars that we hold around the country to teach dental practices to effectively work with medical insurance for various treatments and procedures such as sleep apnea appliances, treatment for TMJD, office visits, x-rays, frenectomies, etc. Here is link to our seminar schedule, we would love to have you join us at one: Hope this helps!
As a periodontist, I am interested if my patients can receive medical benefits for these items: Cone Beam CT scans: Dental Code D0380, D0382, D0383 Intra Oral Scans: 3D Photo Image: D0351 Night Guard: Hard D9944, Soft D9945 Resorbable Membrane: D4266 Bone Graft (Guided Bone Regeneration): D7950 Open Flap Surgery: D4240 or D4241 What choices of Medical Diagnosis codes, etc could be helpful for billing? Thank you!
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