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Aurora
#1 Posted : Friday, September 18, 2020 11:31:16 AM(UTC)
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We have a patient that is looking for help submitting to their medical insurance. We are placing 2 implants due to congenitally missing teeth.

We submitted the CBCT with 70486 and K00.0 and K08.9. Is there something I a missing.

For the pre-d on the implants I have 21248 for the CPT code and K00.0 for the ICD-10. What do you think. Is this enough information to process correctly?

Any information is appreciated!
courtneydsnow
#2 Posted : Friday, September 18, 2020 2:15:42 PM(UTC)
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Hi Aurora!

K00.0 stands for: Anodontia
K08.9 stands for: Disorder of teeth and supporting structures, unspecified

Instead of K08.9, since it is an "unspecified" code, you may instead consider:

K08.89 - Other specified disorders of teeth and supporting structures


And yes, if K00.0 (anodontia) is the reason for the services, that is accurate for your medical claim. Not all medical policies offer coverage for replacement of congenitally missing teeth, so it is important to perform a thorough benefit verification. Showing how the condition is affecting the patients daily function as well (described i your narrative report) is typically important for these types of cases as well.

Hope this helps!
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