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Stephanie
#1 Posted : Tuesday, March 21, 2017 3:48:21 PM(UTC)
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Hello,

My patient was involved in a bike accident and fell on is face! We are needing to file a claim to his medical, are there dental codes for D3310, D2950, D2740, D2940, D5821, D6010, D6065, D6057, D7953 and D8040. The ortho is needed because the fall caused his teeth to shift. I was told to use the code S02.5 for the diagnosis code since it was an accident. I hope you can help me!

Thanks,

Stephanie
courtneydsnow
#2 Posted : Wednesday, March 22, 2017 8:10:39 AM(UTC)
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Hi Stephanie!

No problem, we are happy to help.

Starting off with the diagnosis code(s), i'll need a bit more information to offer you the most specific coding options, so a few questions for you:

1) Was the patient the driver or passenger of the bicycle, or a pedestrian hit by a bicycle?
2) If the patient was either the driver or passenger, what did they hit/run into or how did the accident happen? (did the tire blow out? ran into another bicycle or a car hit them, etc?)
3) Was the teeth shifting the only injury, or were there other issues such as broken/fractured or cracked teeth, teeth that got knocked out, laceration of the lip, etc?

The diagnosis code you list, S02.5 stands for: Fracture of tooth (traumatic)
Which only tells a portion of the story :) You will want a code that describes the accident itself, you can also use an activity code, and possibly other diagnosis codes if there were other injuries besides a traumatic fracture of tooth.
Also, S02.5 by itself is not a billable code, as there are more specific codes available, here they are below:
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
S02.5XXD - Fracture of tooth (traumatic), subsequent encounter for fracture with routine healing
S02.5XXG - Fracture of tooth (traumatic), subsequent encounter for fracture with delayed healing
S02.5XXK - Fracture of tooth (traumatic), subsequent encounter for fracture with nonunion
S02.5XXS - Fracture of tooth (traumatic), sequela


As for the medical codes for the codes you listed:

D6010
- surgical placement of implant body: endosteal implant
can be crosscoded to:
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)

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



D3310 - endodontic therapy anterior tooth (excluding final restoration)
D2950 - core buildup, including any pins when required
D2740 - crown - porcelain/ceramic substrate
D2940 - protective restoration
D5821 - interim partial denture (mandibular)
D6065 - implant supported porcelain/ceramic crown
D6057 - custom fabricated abutment - includes placement
D8040 - Limited orthodontic treatment of the adult dentition

The codes listed above do not have direct crosscodes 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
or
99070 - Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)


Using the JO/JP qualifiers in the red shaded line of the line item in box 24j of the medical claim may help in this case as well.

The following are the codes for tooth numbers, reported with the JP qualifier:
• 1 –32: Permanent dentition
• 51 –82: Permanent supernumerary dentition
• A –T: Primary dentition
• AS –TS: Primary supernumerary dentition

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:
http://www.nucc.org/imag...on_manual_2012_02-v4.pdf

Here are instructions to use the JO/JP qualifiers in your DentalWriter software below:

1) In any claim in DentalWriter, double click on any line item in box 24 (or click in any white box in the line item then click the "edit service" button at the bottom of box 24) in which you wish to add the qualifiers.

2) A "procedure or service" window will appear where you can edit information on that line item. Scroll to the bottom of that window to the "supplemental information" field and type in your desired qualifier with the tooth number(s) or area of the oral cavity codes defined above, then click the "save and close" button in the upper left hand corner of the window, shown below:

3) The text you entered will appear in the red shaded line above the dates of service of the line item you selected, shown below:


Additional instructions for use of the JO and JP qualifiers is provided in the CMS 1500 claim form manual:
• When reporting tooth numbers, add in the following order: qualifier, tooth number, e.g., JP16. When reporting an area of the oral cavity, enter in the following order: qualifier, area of oral cavity code, e.g., JO10.
• When reporting multiple tooth numbers for one procedure, add in the following order: qualifier, tooth number, blank space, tooth number, blank space, tooth number, etc., e.g., JP1 16 17 32.
• When reporting multiple tooth numbers for one procedure, the number of units reported in 24G is the number of teeth involved in the procedure.
• When reporting multiple areas of the oral cavity for one procedure, add in the following order: qualifier, oral cavity code, blank space, oral cavity code, etc., e.g., JO10 20.
• When reporting multiple areas of the oral cavity for one procedure, the number of units reported in 24G is the number of areas of the oral cavity involved in the procedure.


Hope this helps, and I look forward to your response!
Stephanie
#3 Posted : Wednesday, March 22, 2017 3:05:43 PM(UTC)
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Hello,

Thanks for the response. Here is a little more info for your questions.

1) Was the patient the driver or passenger of the bicycle, or a pedestrian hit by a bicycle? He was on a mountain back and he hit a rock causing him to fly face 1st into other rocks.

2) If the patient was either the driver or passenger, what did they hit/run into or how did the accident happen? (did the tire blow out? ran into another bicycle or a car hit them, etc?)
Face first into rocks

3) Was the teeth shifting the only injury, or were there other issues such as broken/fractured or cracked teeth, teeth that got knocked out, laceration of the lip, etc? Cracked teeth, patient lost 24-26 because of accident lacerations to the lips., 7-10 luxated and displaced with fractures.
courtneydsnow
#4 Posted : Thursday, March 23, 2017 7:06:40 AM(UTC)
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Hi guest!

Ok great, here are some coding options below

For the injuries to the oral cavity & lips:

For the fracture:
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
S02.5XXD - Fracture of tooth (traumatic), subsequent encounter for fracture with routine healing
S02.5XXG - Fracture of tooth (traumatic), subsequent encounter for fracture with delayed healing
S02.5XXK - Fracture of tooth (traumatic), subsequent encounter for fracture with nonunion

For the cracked teeth:
K03.81 - Cracked tooth

For the lost teeth:

K08.411 - Partial loss of teeth due to trauma, class I
K08.412 - Partial loss of teeth due to trauma, class II
K08.413 - Partial loss of teeth due to trauma, class III
K08.414 - Partial loss of teeth due to trauma, class IV
K08.419 - Partial loss of teeth due to trauma, unspecified class

For the displacement:
M26.33 - Horizontal displacement of fully erupted tooth or teeth
M26.34 - Vertical displacement of fully erupted tooth or teeth
M26.35 - Rotation of fully erupted tooth or teeth
M26.39 - Other anomalies of tooth position of fully erupted tooth or teeth

For the laceration to lip:
S01.511A - Laceration without foreign body of lip, initial encounter
S01.511D - Laceration without foreign body of lip, subsequent encounter
S01.511S - Laceration without foreign body of lip, sequela


For the accident:

V17.0XXA - Pedal cycle driver injured in collision with fixed or stationary object in nontraffic accident, initial encounter


Hope this helps!
Guest
#5 Posted : Wednesday, July 26, 2017 7:28:58 PM(UTC)
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What is the medical diagnosis code for d0460
courtneydsnow
#6 Posted : Thursday, July 27, 2017 8:15:56 AM(UTC)
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Hi guest!

D0460 - pulp vitality tests

The ICD-10 diagnosis code(s) used will depend on the patients condition. Basically, the diagnosis code will be the reason the pulp vitality test is being performed.

For example, if the pulp vitality test was performed due to traumatic injury to the teeth, you may consider:

S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
K03.81 - Cracked tooth

If the test was done for another reason, let me know what it is and I would be happy to provide some coding options.
Guest
#7 Posted : Wednesday, September 18, 2019 10:19:45 AM(UTC)
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Hi,
What is the cpt code or icd code for dental procedure
D4266
D6058
D6010
D2740
D6057

Thanks,
Tameka
courtneydsnow
#8 Posted : Wednesday, September 18, 2019 5:16:46 PM(UTC)
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courtneydsnow

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Hi Tameka!

D4266 - guided tissue regeneration - resorbable barrier, per site
can be cross coded to:
41870 - Periodontal mucosal grafting

D6010 - surgical placement of implant body: endosteal implant
can be cross coded to:
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)



D6058 - abutment supported porcelain/ceramic crown
D2740 - crown - porcelain/ceramic substrate
D6057 - custom fabricated abutment - includes placement

The codes listed above do not have direct crosscodes 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!
Guest
#9 Posted : Thursday, February 20, 2020 11:11:01 AM(UTC)
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Hello I'm not sure if my previous questions posted so I'm going to repost ..

For custom abutment, what is the diagnosis code and for a abutment supported implant crown

Do either of those codes require modifer or Qual?


FC

Edited by user Thursday, February 20, 2020 11:12:58 AM(UTC)  | Reason: fc

courtneydsnow
#10 Posted : Friday, February 21, 2020 9:07:29 AM(UTC)
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courtneydsnow

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Hi Guest!

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.
Column
#11 Posted : Saturday, February 22, 2020 8:56:34 AM(UTC)
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Posts: 1

Thanks! It's very useful information.
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