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Hi Guest!
You will certainly want to confirm these diagnosis codes with your provider, however based on what you described, here are some diagnosis coding options:
K03.81 - Cracked tooth
Partial loss of teeth, due to periodontal diseases:
o K08.421 - Partial loss of teeth due to periodontal diseases, class I
o K08.422 - Partial loss of teeth due to periodontal diseases, class II
o K08.423 - Partial loss of teeth due to periodontal diseases, class III
o K08.424 - Partial loss of teeth due to periodontal diseases, class IV
o K08.429 - Partial loss of teeth due to periodontal diseases, unspecified class
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 class
Depending on your case/condition, there are may additional options as well, such as:
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
Hope this helps!
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Thank you for your reply above. Since my dentist office is not providing any help since they don't do health forms. I am going to have to attempt to do this on my own. I read my original question and realized I wasn't very clear. The tooth extraction due to the infection and the cracked tooth was done 3-4 years ago. The primary reason for the. cone beam scan done now was to check for the health of the bone for dental implants. So do I add the code for cracked tooth and periodontal disease and also is there a place where I can read what the diagnosis code means is that I can determine what is minimal/moderate/ and severe.
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Hi,
I am trying to get coverage through my medical for a D0364. The reason was for a suspected cyst/tumor in the anterior mandible (symptoms included tenderness on palpation). Regular x-rays didn't show anything.
My medical insurance carrier is Aetna Choice POS II.
Can you recommend if I should bill the D code or try one of the previous mentioned unspecified CPT codes? What would you recommend for the ICD-10? And is there a separate code for getting a full radiology report for the cone beam?
Thank you!
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Hi Guest!
D0364 - Cone beam CT capture and interpretation with limited field of view - less than one whole jaw
Unfortunately Aetna does not seem to have clarification in their medical coverage policy for coding for medically related CBCT, unless i am overlooking it, so you may consider the "D" code first and if they cannot process that code, then one of the alternative CPT codes mentioned in previous posts.
As for the ICD code(s), it looks like the only thing that has been confirmed in the tenderness, so you may be looking at option such as:
G50.1 - Atypical facial pain
R68.84 - Jaw pain
Z12.81 - Encounter for screening for malignant neoplasm of oral cavity
As for the code for the rendering and interpretation, below are come coding options:
76376 - 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image post-processing on an independent workstation
76377 - 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation
Hope this helps!
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Currently we are taking a CBCT scan in creating an oral appliance to treat sleep apnea. We are using codes 76102, 70220, 70320, 72040, and 70140. Would this be considered unbundling? Edited by user Tuesday, February 18, 2020 11:45:02 AM(UTC)
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Hi Guest!
Great question - yes we do not recommend breaking down the CBCT into several separate x-ray codes
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Hello Courtney.
Trying to bill for a CBCT that is for cranial distortions and TMJ issues which is not dental.
M26.10 Unspecified anomaly of jaw-cranial base relationship.
What is best medical code to use.
As soon a the big "D" is put in front of a code, the insurance personnel seem to get blinders on and become deaf, blind, and ignorant to any type of narrative.
As always, thank you for your help
Michael :)
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Hi Michael!
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 UHC's radiology medical policy does state this is the correct code to use for CBCT, 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) We also see practices billing out for "76102 - Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography), other than with urography; bilateral"
Hope this helps!
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My son had a conebeam scan in an orthodontist's office for reviewing whether he needed another bone graft surgery or not ( history of cleft lip and palate ). The hospital filed a claim for the conebeam with BOTH medical and dental insurance. My question is this allowed to file two claims for one scan, and if so, is it allowed to submit a different charge for medical v. dental? I feel like they are charging me twice. The dental code was D0364, cone beam less than whole jaw The medical code was 70486, CAT scan of face/jaw Thank you ps I just got off the phone with the hospital, and they said the medical code was for the reading of the scan and that modifiers to this code would not show up on my eob. So I asked my insurance, and they said there were no modifiers. Still confused. Edited by user Thursday, April 2, 2020 10:05:23 AM(UTC)
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Hi Guest!
No, it is not appropriate for a provider to bill both dental and medical insurance for the same procedure at the same time. However, it is common practice to bill one insurance first and if denied, bill to the other insurance. (for example, if the CBCT was billed to medical and denied as not medically necessary, may be billed to dental after the medical claim has completed processing).
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Hi-
My child needs her wisdom teeth out. She has had a lot of pain. On exam, the in network oral surgeon discovered one or her wisdom teeth had grown into or very close to the facial nerve. The surgeon's office submitted a claim for a cone beam to Northeast Delta Dental but it was denied. Is there another code that can be used to cover this test in this circumstance?
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Hi Guest!
I can't say if there is a different code used without knowing what code was submitted, however -
it may be worth it to check into medical insurance coverage for this instead of dental! Many medical insurers indicate CPT (medical)code 70486 for cone beam CT scan (UHC, for example).
Here are the dental codes for cone beam CT's:
D0363 - Cone-Beam 3D multi image reconstruction
D0364 - Cone beam CT capture and interpretation with limited field of view - less than one whole jaw
D0365 - Cone beam CT capture and interpretation with field of view of one full dental arc - mandible
D0366 - Cone beam CT capture and interpretation with field of view of one full dental arch - maxilla, with or without cranium
D0367 - Cone beam CT capture with interpretation with field of view of both jaws, with or without cranium
D0368 - Cone beam CT capture and interpretation for TMJ series including two or more exposures
D0380 - Cone beam CT image capture with limited field of view - less than one whole jaw
D0381 - Cone beam CT image capture with field of view of one full dental arch - mandible
D0382 - Cone beam CT image capture with field of view of one full dental arch - maxilla, with or without cranium
D0383 - Cone beam CT image capture with field of view of both jaws, with or without cranium
D0384 - Cone beam CT image capture for TMJ series including two or more exposures
Hope this helps!
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For TMJ CBCT can a CPT 76102 be used? And if we are taking separate open and closed view at same visit than can we bill 2 units for that code?
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Hi guest!
Great question. 70486 is the most common code used to represent cone beam CT's currently. For example, evicore's head imaging guidelines state the following:
Cone Beam CT: Report with CPT® Codes: CPT® 70486, CPT® 70487, CPT® 70488, CPT® 70480, CPT® 70482
However, we have run into some insurers that do not want cone beam CT reported with 70486 because it does not specify the word "cone beam" in its description, in which we typically suggest to consider 76102 or 76497 (Unlisted computed tomography procedure (eg, diagnostic, interventional))
Hope this helps!
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Hi Courtney, this thread is great. I am interested in an update on CBCT coverage in obstructive sleep apnea cases, as in the case of a full time dental sleep practice medical billing. It seems like OSA cases are trickier than implants, TMJ, and reconstruction.
The specific medical insurances I'm curious about coverage for sleep tx are the following: BCBS, United, Tricare, and Medicare.
I know Medicare only pays under E0486(the appliance), so doesn't pay for the exam, imaging, etc.
Do the rest use 70486 or an unlisted tomography code or are there new codes for CBCT? Thank you for your help!
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Hi DTI2!
Great question. You're correct, it is far less common for a medical insurer to cover CBCT for a diagnosis of Obstructive Sleep Apnea (G47.33). It is typically deemed "not medically necessary" for that diagnosis at this point in time.
And yes, 70486 is the most common CPT code used to represent CBCT at this point in time. Heads up, it does typically require a pre-authorization for coverage!
Hope this helps :)
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