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Hi Sabrina Khan! No problem 🙂 A few i have seen deemed medically necessary through Medicare that are not trauma related (some did include a trauma code as one of them though): M27.2 – Inflammatory conditions of jaw M27.8 – Fibrous dysplasia of jaw M26.70 – Deformity of jaw K12.2 – Cellulitis and abscess of mouth K04.6 – Periapical abscess with sinus K04.7 – Periapical abscess without sinus And of course, Malignant Neoplasms: 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 Hope this helps!
Thank you so much for that information!!You definitely know what you are talking about! Do you know what are the most common ICD-10 codes that Medicare approves for bone grafts and reconstructions? What should I be looking out for in my office as a potential case that is deemed medically necessary? Can you list the top 10? Any help would be greatly appreciated.
Hi Sabrina Khan! Great question, here are some helpful tid-bits! for 21210 & 21215: the 52 modifier may be used if bone was not harvested from the patient For all: the 51 modifier may be used to indicate multiple surgeries on the same day, although, depending on what Medicare Part B jurisdiction you are in, some of them state on their website that “Note: Medicare doesn’t recommend reporting Modifier 51 on your claim; our processing system will append the modifier to the correct procedure code as appropriate.”. Here is a link to this information on Jurisdiction H”s website: I have also been told that using the JO qualifiers in the red shaded line of the line item for bone grafts and implants can help with smoother claim processing. The following are the codes for areas of the oral cavity, reported with the JO qualifier: • 00 : Entire oral cavity • 01 : Maxillary arch • 02 : Mandibular arch • 10 : Upper right quadrant • 20 : Upper left quadrant • 30 : Lower left quadrant • 40 : Lower right quadrant Examples of how this would look on the medical claim can be found in the NUCC”s CMS 1500 claim form manual here, starting on page 46 & 47: Hope this helps!
Does anyone know if Medicare requires any specific Qualifiers, Modifiers or descriptions above or below the CPT codes 21210,21215,21248 and 21249? I have the narratives and operative reports for a couple cases, but I just want clarification on what needs to go on the claim. My doctor is already certified for Oral Surgery with Medicare. Thank you
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