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Guest
#1 Posted : Thursday, May 28, 2020 3:38:38 PM(UTC)
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Guest

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Front tooth was broken under the gum line due to trauma. The medical insurance dental rider covers this repair but we have been frustrated as the dental office is unfamiliar with medical claims submissions and the insurance provider is completely unhelpful.

We need to find the medical insurance codes to finish the permanent tooth installation:
D6057 - Custom abutment
D6058 - Permanent crown

Can you provide the corresponding medical codes?

THanks!

courtneydsnow
#2 Posted : Thursday, May 28, 2020 4:07:08 PM(UTC)
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courtneydsnow

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Hi Guest!

No problem, based on what you described, here are some coding options below:

ICD (diagnosis)
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture


CPT (procedure)
D6057 - custom fabricated abutment - includes placement
D6058 - abutment supported porcelain/ceramic crown

The codes listed above does not have a 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

Hope this helps!
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