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Question Major reconstruction with dental implants - I need help with correct medical codes for dental procedures
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JennS
#1 Posted : Monday, July 29, 2019 10:45:54 AM(UTC)
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JennS

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Our oral surgery office does a lot of "All on 4" implant cases. This involves full mouth extractions with alveoplasty in each quad, and placement of dental implants in an outpatient surgery center. I'm struggling with all the correct codes to send to medical insurance. Most of the time these surgeries are only due to decay in multiple areas, periodontal issues, or they are just unhappy with full dentures. The patient prefers to replace the existing teeth that already have a guarded prognosis with implants. It's more of a "big picture" treatment plan.

I appreciate your help!
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courtneydsnow
#2 Posted : Monday, July 29, 2019 1:58:18 PM(UTC)
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courtneydsnow

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Hi JennS!

No problem. So as you alluded to - not all implants cases meet the medical necessity requirements for medical insurance coverage. But, for the ones that do, here are some commonly used diagnosis coding options for what you described:

Diagnosis:

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
K12.2 - Cellulitis and abscess of mouth
K04.6 - Periapical abscess with sinus
K04.7 - Periapical abscess without sinus
K04.1 - Necrosis of pulp
K04.2 - Pulp degeneration
K04.01 - Reversible pulpitis
K04.02 - Irreversible pulpitis
• K05.211 - Aggressive periodontitis, localized, slight
• K05.212 - Aggressive periodontitis, localized, moderate
• K05.213 - Aggressive periodontitis, localized, severe
• K05.219 - Aggressive periodontitis, localized, unspecified severity
• K05.221 - Aggressive periodontitis, generalized, slight
• K05.222 - Aggressive periodontitis, generalized, moderate
• K05.223 - Aggressive periodontitis, generalized, severe
• K05.229 - Aggressive periodontitis, generalized, unspecified severity
• K05.311 - Chronic periodontitis, localized, slight
• K05.312 - Chronic periodontitis, localized, moderate
• K05.313 - Chronic periodontitis, localized, severe
• K05.319 - Chronic periodontitis, localized, unspecified severity
• K05.321 - Chronic periodontitis, generalized, slight
• K05.322 - Chronic periodontitis, generalized, moderate
• K05.323 - Chronic periodontitis, generalized, severe
• K05.329 - Chronic periodontitis, generalized, unspecified severity
• K05.10 - Chronic gingivitis, plaque induced
• K05.11 - Chronic gingivitis, non-plaque induced
• K02.3 - Arrested dental caries
• K02.51 - Dental caries on pit and fissure surface limited to enamel
• K02.52 - Dental caries on pit and fissure surface penetrating into dentin
• K02.53 - Dental caries on pit and fissure surface penetrating into pulp
• K02.61 - Dental caries on smooth surface limited to enamel
• K02.62 - Dental caries on smooth surface penetrating into dentin
• K02.63 - Dental caries on smooth surface penetrating into pulp
• K02.7 - Dental root caries
• K02.9 - Dental caries, unspecified
K03.81 - Cracked tooth
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
S03.2XXA - Dislocation of tooth, initial encounter
M26.34 - Vertical displacement of fully erupted tooth or teeth
M26.33 - Horizontal displacement of fully erupted tooth or teeth

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 caries:
o K08.431 - Partial loss of teeth due to caries, class I
o K08.432 - Partial loss of teeth due to caries, class II
o K08.433 - Partial loss of teeth due to caries, class III
o K08.434 - Partial loss of teeth due to caries, class IV
o K08.439 - Partial loss of teeth due to caries, unspecified class

Partial loss of teeth, due to trauma:
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

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


Hope this helps!
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Guest
#3 Posted : Monday, July 29, 2019 7:07:19 PM(UTC)
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Guest

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Is there a CPT code for removal of infected maxillary subperiosteal implant? The closest I can find is 21299 for unlisted craniofacial and maxillofacial proceurues.
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courtneydsnow
#4 Posted : Tuesday, July 30, 2019 8:33:40 AM(UTC)
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courtneydsnow

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Hi Guest!

Here are some coding options for you:

20670 - Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)
20680 - Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)

Hope this helps!
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Guest
#5 Posted : Tuesday, July 30, 2019 10:14:50 AM(UTC)
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Thank you, that does help. Can you tell me the difference between the classI, ClassII and ClassII in the ICD 10 codes K08.111, .112, and .113?
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courtneydsnow
#6 Posted : Tuesday, July 30, 2019 10:21:47 AM(UTC)
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courtneydsnow

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Hi Guest!

You're welcome. And no problem, here is a link to a presentation that provides more details on determination the class:
https://www.prosthodontics.org/assets/1/7/ACP_PDI_Partial_Edentulism1.pdf

Hope this helps!
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Guest
#7 Posted : Sunday, January 12, 2020 1:09:25 AM(UTC)
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Hi, 3 of my teeth that had supported a bridge for a long time eventually cracked and broke. One split into half all the way down to the root but was able to be pulled out. 2 of them broke at the gum line and required surgical extraction. I then had implants and a new bridge. All 3 teeth have had root canal done about 20 years ago and I think they broke simply due to wear and tear.

I need to know what diagnosis code to use for my medical insurance claim for the cutting procedure. I looked through all the relevant Q&A in this forum but couldn't find a similar situation for the iCD 10 code. Can you help?

Thank you.

JL
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courtneydsnow
#8 Posted : Monday, January 13, 2020 11:42:45 AM(UTC)
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courtneydsnow

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Hi JL!

You will certainly want to confirm any diagnosis codes with your provider, but based on what you described, here are some coding options for you:

K03.81 - Cracked tooth
K08.3 - Retained dental root
K08.531 - Fractured dental restorative material with loss of material
K08.539 - Fractured dental restorative material, unspecified


Hope this helps!
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