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I have a patient involved in an auto accident. She was the driver of the car and was hit in the face with the air bag. Her front bridge broke and she now needs a 3 unit implant bridge. Can you help with diagnosis and procedure codes? Thanks
Hi Christian! No problem. Just a heads up, most medical insurers do stipulate that in order for accidental injury to teeth to be covered by medical insurance, the injury needs to be to “sound, natural teeth” – so since the damage was done to a bridge, it may not be covered. Having said that, let”s start with the ICD-10 (diagnosis) coding options: For the fractured bridge: K08.530 – Fractured dental restorative material without loss of material K08.531 – Fractured dental restorative material with loss of material If there was pain due to the trauma: G89.11 – Acute pain due to trauma Now, to describe the accident, they get very specific! I understand it was the driver, depending on if the collision was with another vehicle or not and what type also affects the code. For example, here are some that may fit your case: V43.51XA – Car driver injured in collision with sport utility vehicle in traffic accident, initial encounter V43.52XA – Car driver injured in collision with other type car in traffic accident, initial encounter V43.53XA – Car driver injured in collision with pick-up truck in traffic accident, initial encounter V43.54XA – Car driver injured in collision with van in traffic accident, initial encounter If it was a collision with a stationary object, bicyclist, animal, etc – let me know and I can provide you a more specific code for the situation. Now for the procedure (CPT) coding: Implant bridges do 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), or you can use the CPT code below and include a narrative report describing the procedure: 41899 – Unlisted procedure, dentoalveolar structures Hope this helps!
how do you code immediate- implant is placed at the same time as the natural tooth is extracted. and ICD-10 for this
Hi Guest! You would code the implant and the extraction separately. Here are the codes for implants: 21248 – Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3or less) 21249 – Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more) As for extractions, there is not currently a CPT code to represent extractions, 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 try the CPT code below and include a narrative report describing the procedure: 41899 – Unlisted procedure, dentoalveolar structures *use the 51 modifier to indicate multiple procedures performed on the same day, appended to the lesser of the services. As for diagnosis code(s) – this will depend on the patient”s condition, or basically why are the services being done. If you could provide me some details on that, i would be happy to offer you some coding options. Hope this helps!
I am the patient and need help with getting my dental covered by my medical and there are NO dental offices in my county that know how to bill medical for anything. I fell due to having a bad ankle joint (it was very loose and weak) and I’ve had the joint surgically repaired so there is an Ortho that has diagnosed me with this issue and used codes 717.87 and M25.373 for diagnosis. When I fell I busted one tooth completely to the gum line(root left), 2 teeth pretty close to the gum line, had a crown on one of the teeth and the pieces of tooth broke other teeth when I slammed my chin. I was on a ladder and when I put my weight onto my right ankle and lifted up my left leg and fell due to the pain in my ankle weight bearing. I hit my teeth on one ladder rung and my chin on the next. I am trying to figure out what codes need to be used for extraction (normal and surgical), and for all the dental implant stuff and what diagnosis codes to use. I’m a medical assistant very familiar with billing but was never taught the dental side of medical billing. I appreciate any and all help you are able to provide and insurance is BC/BS employer provided PPO.
Hi Guest! No problem i”m happy to help in any way I can 🙂 Let”s start with the diagnosis codes based on what you described. Here are some possibilities below: First, the two you mentioned: M25.373 stands for: Other instability, unspecified ankle As for 717.87, i actually don”t show that as a valid ICD code – did you mean to type something else? For the damage to the teeth: 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 M26.34 – Vertical displacement of fully erupted tooth or teeth M26.33 – Horizontal displacement of fully erupted tooth or teeth K08.531 – Fractured dental restorative material with loss of material K08.530 – Fractured dental restorative material without loss of material For the fall: W11.XXXA – Fall on and from ladder, initial encounter W11.XXXD – Fall on and from ladder, subsequent encounter As for the procedures: there is actually not a direct crosscode for CPT, 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 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: 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) Of course, if there are any associated office visits those can be reported using evaluation & management (E&M) codes, and if there are any x-rays associated. For example, if a pano x-ray is formed, the CPT code is 70355. Hope this helps!
Hi- Im looking for a medical procedure code and diagnosis code for a 12 yo diabled boy who fell onto some poorly placed metal bleachers at an indoor sports complex and cracked 2 front teeth in half. His disability required him to have the procedure done at a children”s hospital a month after the event where he was placed under general anesthesia. Dental insurance will not pay for the hospital stay (dental proc code D9420 hosp/surg ctr calls) and it seems like something medical should pay for but they keep kicking it back to dental because of codes– so need xref and diag code..(im thinking 99221 + K08.411 – Partial loss of teeth due to trauma, class I–??? Thanks for any help..
What about an ER patient had a seizure and two front teeth came loose. The doctor reimplanted the two teeth? What procedure code should I use?
Hi Guest! D7270 – Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth In Aetna”s crosswalk for “Oral Surgery Medical In Nature”, the crosscode for D7270 is listed as: 21140 – Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure) or you can use the CPT codes below and include a narrative report describing the procedure(s): 41899 – Unlisted procedure, dentoalveolar structures Hope this helps!
Thank you for the additional information! Here is what I found based on the accident. ICD-10-CM Diagnosis Code V86.56 Driver of dirt bike or motor/cross bike injured in nontraffic accident Driver of dirt bike or motor/cross bike injured nontraffic S02.5XXA – Fracture of tooth (traumatic), initial encounter for closed fracture or S02.5XXB – Fracture of tooth (traumatic), initial encounter for open fracture Partial loss of teeth, due to other specified cause: K08.491 – Partial loss of teeth due to other specified cause, class I K08.492 – Partial loss of teeth due to other specified cause, class II K08.493 – Partial loss of teeth due to other specified cause, class III K08.494 – Partial loss of teeth due to other specified cause, class IV K08.499 – Partial loss of teeth due to other specified cause, unspecified Partial loss of teeth, unspecified cause: K08.401 – Partial loss of teeth, unspecified cause, class I K08.402 – Partial loss of teeth, unspecified cause, class II K08.403 – Partial loss of teeth, unspecified cause, class III K08.404 – Partial loss of teeth, unspecified cause, class IV K08.409 – Partial loss of teeth, unspecified cause, unspecified class D0140 – limited oral evaluation – problem focused Can be crosscoded to: 99201 – Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient”s and/or family”s needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. or 99211 – Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. 99058- Emergency care Or 99050 Emergency Care after hours Use in addition to the evaluation and management code D5821 – interim partial denture (mandibular) The code listed above 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), or you can try the CPT codes below and include a narrative report describing the procedure: 41899 – Unlisted procedure, dentoalveolar structures Hope this helps!
Hi Guest! I need a little more detail to help with diagnosis codes. Can you please tell me if the pt. was the driver or a passenger of the dirt bike? were they in traffic? why did the pt. need the partial… did they fracture or loose teeth in the accident? Thank you
Hello, He was the driver of the dirt bike. I don”t believe he was in traffic. Yes he fractured teeth and he lost some so we are making a temporary flipper for him to fill the space until he is old enough for an implant. This pt is 16 years old. Thanks!
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