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#1 Posted : Tuesday, April 21, 2020 9:37:30 AM(UTC)

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Dental Procedure Code to Medical Diagnostic code

I had a Dental Procedure done by an Oral Surgeon...had an infection under the gum on the implants.

D7953 Bone repl Grft ridge prsv/site
D4240 Ging Flap, root Pin, 4+ per quad.

What would the Diagnostic code be I am getting so annoyed with the medical insurance since I have to submit on my own claim because the Dentist does not take coverage. UGH

hope you can help with this...getting annoyed with the insurance company stringing me along, this is the third time it has been submitted to them. First to time there ignore me and would not take the claim from me and then the doctor submitted claim and it sat unattended too, a nice customer rep found in the que sitting since 10/23/2019, so I was advise to resubmit it again last week and now I get this one.
#2 Posted : Thursday, May 7, 2020 10:15:03 AM(UTC)

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Hi Guest!

As for the procedure (CPT) codes for the services you listed:

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

D4240 - gingival flap procedure, including root planing - four or more contiguous teeth or tooth bounded spaces per quadrant

The code listed above does not have direct crosscode 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

As for the diagnosis (ICD) code(s) - it all depends on your condition. Based on what you described, here are some possibilities, but i would certainly verify these with your doctor:
K12.2 - Cellulitis and abscess of mouth
T84.7XXA - Infection and inflammatory reaction due to other internal orthopedic prosthetic devices, implants and grafts, initial encounter
K05.211 - Aggressive periodontitis, localized, slight
K05.212 - Aggressive periodontitis, localized, moderate
K05.213 - Aggressive periodontitis, localized, severe
K05.311 - Chronic periodontitis, localized, slight
K05.312 - Chronic periodontitis, localized, moderate
K05.313 - Chronic periodontitis, localized, severe

Hope this helps!
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