What are the diagnosis codes for TMD? (Temporomandibular Disorders)

There are many ICD-9 diagnosis codes for jaw pain, facial pain, headaches, etc – however – there are only a few ICD-9 diagnosis codes that truly stand for a Temporomandibular Disorder!!!!

While various pain and accidents ICD-9 codes generally accompany the TMD diagnosis codes on a medical insurance claim, many times just the pain or accident code themselves do not establish medical necessity for treatment unless a TMD diagnosis code is present on the claim as well. (i.e. – just a headache alone does not establish medical necessity for treatment, but a headache AND a TMD does make it medically necessary for treatment!)

Here are the TMD ICD-9 codes:
• 524.60 - TMD’s unspecified
• 524.61 - TMD’s, adhesions and ankylosis (bony of fibrous)
• 524.62 - TMD’s, arthralgia of TMJ
• 524.63 - TMD’s, articular disc disorder (reducing or non-reducing)
• 524.64 - TMJ sounds on opening and/or closing the jaw
• 524.69 - Other specified TMD’s

Here are some examples of pain ICD-9 codes:
• 784.0 – Headache
• 784.92 – Jaw pain
• 729.1 - Myalgia and myositis, unspecified
• 729.2 - Neuralgia, neuritis, and radiculitis, unspecified
• 338.11 - Acute pain due to trauma
• 338.21 Chronic pain due to trauma
• 350.2 – Atypical facial pain


Here are some examples of accident ICD-9 codes:
• E884.2 - Accidental fall from chair
• E884.4 – Accidental fall from bed
• E885.3 – Accidental fall from skis
• E929.3 – Late effects of accidental fall
• E814.7 - Motor vehicle traffic accident involving collision with pedestrian injuring pedestrian


It is always important to check the medical policy for TMD’s when working with a new medical insurer! Here is an example TMD policy from Aetna that outlines what services and treatments are covered, and are not covered for treatment of diagnosed TMD. The policy also outlines (toward the bottom in the charts) what diagnosis and procedure codes are covered and non-covered by the policy!

http://www.aetna.com/cpb...cal/data/1_99/0028.html

You can normally find the medical policy on the insurers website in their “medical policies”, “policies, procedures & guidelines”, “practice resources”, or “Clinical Policy Bulletins” sections. If you are unable to locate the policy online, you can call the insurer and request a copy of the policy!

Edited by user Tuesday, September 30, 2014 8:56:21 AM(UTC)  | Reason: Not specified