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Guest 1
#1 Posted : Friday, July 31, 2020 11:11:07 AM(UTC)
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Guest

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Hi, I'm looking for Aetna Medicare Advantage Plan Medically Necessary Rembursment CPT Codes and Dignostic Codes for...

Oral pain Swallowing

Oral pain Chewing



Does pathology 8305 need an ICD code? (Billed not rembursment)


D7550 cavitation of previously extracted tooth 32

D9248

Suture of extracted tooth 30

Wound dressing

Laser Theraphy- light walker

41870

41899

21210-21215

D5283

Nesbit

Nesbit Insert/Adjust

Ozone Multiple Visit

Membrane Removal

Edited by user Friday, July 31, 2020 3:19:20 PM(UTC)  | Reason: Mistake

courtneydsnow
#2 Posted : Tuesday, August 4, 2020 8:51:44 AM(UTC)
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courtneydsnow

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Hi Guest 1!

Odynophagia (painful swallowing) currently falls under:
R13.10 - Dysphagia, unspecified

As for painful chewing, you may consider:
R63.8 - Other symptoms and signs concerning food and fluid intake
R68.84 - Jaw pain
M79.11 - Myalgia of mastication muscle
R52 - Pain, unspecified
K08.89 - Other specified disorders of teeth and supporting structures


And yes, every medical claim/service you file requires at least 1 ICD-10 code. Typically, for biopsies, you will be using a benign or malignant neoplasm code, for example:
D10.0 - Benign neoplasm of lip
D10.1 - Benign neoplasm of tongue
D10.2 - Benign neoplasm of floor of mouth
D10.30 - Benign neoplasm of unspecified part of mouth
D10.39 - Benign neoplasm of other parts of mouth
D10.4 - Benign neoplasm of tonsil


D7550 - partial ostectomy/sequestrectomy for removal of non-vital bone
can be crosscoded to:
21025 - excision of bone, mandible
21026 - excision of facial bone(s)
41830 - alveolectomy incl. curettage


D9248 - non-intravenous conscious sedation
For patients 5+ years old, can be cross coded to:
99152
Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older
99153
Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; each additional 15 minutes intraservice time (list separately in addition to code for primary service)


For a suture, you may consider:
40831 – Closure of laceration, vestibule of mouth; over 2.5 cm or complex
or:
you can use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures


As for the wound dressing, there are many codes available depending on what type was used. For example, here is a list of several different types in a cardinal health policy:
https://www.cardinalhealth.com/content/dam/corp/web/documents/Manual/cardinal-health-2019-wound-care-supplies-pocket-coding-guide.pdf


For low-lower laser:
S8948 - Application of a modality (requiring constant provider attendance) to one or more areas; low-level laser; each 15 minutes


41870 stands for: Periodontal mucosal grafting
21210 stands for: graft, bone; nasal, maxillary, or malar areas
21215 stands for: Graft, bone; mandible (includes obtaining graft)


As for:
D5283 - removable unilateral partial denture – one piece cast metal. (including clasps and teeth), mandibular
as well as Nesbit, Nesbit Insert/Adjus, Ozone Multiple Visit and Membrane Removal:

There are not direct CPT crosscodes available that we are aware of for these services, so you can either use the "D" code on the medical claim (many medical insurers will process the D code when the services are medically necessary and there is not a direct CPT crosscode available), or you use an unlisted/misc procedure code and include a narrative report describing the procedure, such as:
41899 - Unlisted procedure, dentoalveolar structures
40899 - Unlisted procedure, vestibule of mouth


Hope this helps!
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