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I accidentally fell on a concrete drive bursting my upper lip from nose through lip, bursting gum underneath, all requiring ER visit with stitches which insurance paid. But the front tooth was broken off at the gum line during the accident, requiring extraction of the broken tooth, a bone graft graft and an plant. Medical insurance denied claim on dental procedures, saying it was improperly billed. Periodontist office does not have correct billing codes for billing these under medical claim. Please help.
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Hi Barbara Henson!
Based on what you described, here are some CPT (procedure) coding options for you:
For the bone graft:
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
For the implant:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial (3 or less)
Extractions do not have a direct crosscode - 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
You will also need ICD-10 (diagnosis) codes to describe the injury to the teeth and how it happened. Based on what you described, here are some coding options:
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
G89.11 - Acute pain due to trauma
W01.0XXA - Fall on same level from slipping, tripping and stumbling without subsequent striking against object, initial encounter
Hope this helps!
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