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S8262 Replacement
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Sarah
#1 Posted : Thursday, November 19, 2015 1:50:50 PM(UTC)
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I still don't have a viable replacement code for S8262 for the custom oral splints. The suggestions I was given were 21085, 21089, 21499, and 21110. The first three are being shot back as surgical, and the last one involves wiring. It has been months and between the deletion of S8262 and the ICD-10 issues my office had I am hitting a wall. Splints are 75% of our practice and I'm not finding any help. Does anyone know a viable code?
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courtneydsnow
#2 Posted : Thursday, November 19, 2015 2:32:53 PM(UTC)
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courtneydsnow

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Hi Sara!

Great question. What we are finding is that the code that is most commonly accepted by medical insurers currently for TMD appliances since the S8262 discontinuation is D7880. However, some insurers are accepting D7899, or E1399.

D7880 - occlusal orthotic device, by report
D7899 - unspecified TMD therapy, by report
Or, if the medical insurer says they won’t process the “D” codes (most will these days, but you will run into a few that won’t), you can try:
E1399 - Durable medical equipment, miscellaneous

A narrative report accompanying the claim is recommended since they are all "by report" or "miscellaneous" codes.

You can also check the insurers TMD medical policy on their website, and many of them will list accepted codes right in their policies. For example, here is a link to BCBS of MS's TMD medical policy that lists the currently accepted code as D7880 for TMD appliances in the coding section of the policy:
http://www.bcbsms.com/com/bcbsms/apps/PolicySearch/views/ViewPolicy.php?&noprint=yes&path=/policy/emed/Temporomandibular_Joint.html

Hope this helps, have a great day!

Edited by user Thursday, November 19, 2015 2:55:43 PM(UTC)  | Reason: Not specified
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Orofacial Pain Biller
#3 Posted : Thursday, December 10, 2015 8:30:59 AM(UTC)
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I've been using code 21089 which is an unlisted maxillofacial procedure. You must send a descriptive letter explaining exactly what the procedure is and why it is medically necessary. Not doing so will only hold up the claim while they request records or a description of services. We have gotten excellent reimbursement ($1500-$5400 per Orthotic Splint depending on ins co.) using this code attached to the claim. All major medical insurance companies we work with have accepted our use of the code. Hope this helps!
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