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Hi,
What procedural code should be used when a patient has their TMJ orthotic adjusted? We submitted a claim using 21089 and it was denied because that code is unlisted. Provider is Carefirst BCBS if that makes a difference.
An adjustment is when the patient comes in, is hooked up to the TENS unit, and then any tooth to orthotic contacts that are incorrect are ground away.
If you need more info, please let me know.
Thanks in advance for any advice
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Rank: Administration
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Hi Guest!
Great question. Most practices we work with choose to bill follow up TMD appointments using established patient E&M codes (i.e. 99211, 99212, 99213).
TENS does have its own code you can use, although heads up, most medical insurers will not offer coverage for TENS for a diagnosis of TMD as is it currently considered "experimental & investigational" for TMD by many medical insurer. That codes is 64550 - Application of surface (transcutaneous) neurostimulator.
Hope this helps!
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Rank: Guest
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Hi- Is there a guideline to determine which E/M office visit code someone should use to bill services to treat TMJ or OSA?
Thanks,
Briana
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Rank: Administration
Joined: 11/21/2012(UTC)
Posts: 1,732
Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
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Hi Briana!
Great question. Typically dental practices performing an evaluation for TMD and OSA will have the documentation to support a level 1 or 2, sometimes a level 3 (i.e. 99201-99203 for new patients, 99211-99213 for established patients).
The level of code should be selected based on three items:
1) the level of history collected from the patient (problem focused, expanded problem focused, detailed, or comprehensive)
2) the level of examination performed (problem focused, expanded problem focused, detailed or comprehensive) **keep in mind a comprehensive oral exam does not qualify on it's own as a comprehensive medical evaluation
3) the level of medical decision made (complexity that is straightforward, low, moderate high)
Of course, the level 4 and 5 codes require detailed or comprehensive history taking and exams, and medical decision making of moderate and high complexity, which is why many dental practices will fall into the level 1-3 visits.
Hope this helps!
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