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Guest
#1 Posted : Tuesday, February 16, 2016 8:29:35 AM(UTC)
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Guest

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I need help finding the equivalent medical codes for dental surgery.

I am scheduled for the following: A tooth broken as a child, abscessed, root canal performed, and capped broke again below the gum line. An implant is the only long term solution. The remaining tooth has to be extracted and bone grafted. Bone loss probably due to the abscess long ago. The office performing this procedure doesn't have the means to convert the dental codes to medical codes to get preauthorization and hopefully some help for paying this very expensive surgery.

D7210 Tooth #24 Surgical extraction

D7950 site #24 Ridge augmentation/osseous grafting

D6010 site #24 Surgical placement of implant

In addition, I will be having an additional surgery in another area that involves a sinus lift. Are there medical codes for that as well. I don't have the dental code yet.

Thank you for your help.
courtneydsnow
#2 Posted : Tuesday, February 16, 2016 10:06:19 AM(UTC)
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courtneydsnow

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Hi guest!

D7210 - surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated

The code listed above 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 try the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures


D7950 - osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla - autogenous or nonautogenous, by report
can be crosscoded to:
21210 - Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)
21215 - Graft, bone; mandible (includes obtaining graft)
*The modifier -52 for "reduced services" can be used when bone is not obtained from the patient.

D6010 - surgical placement of implant body: endosteal implant
can be crosscoded to:
21248 Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial
21249 Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete

As for the sinus lift:
D7951 - sinus augmentation with bone or bone substitutes via a lateral open approach
D7952 - sinus augmentation via a vertical approach

21210 - graft, bone; nasal, maxillary, or malar areas
or
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 try the CPT code below and include a narrative report describing the procedure:
21299 - Unlisted craniofacial and maxillofacial procedure

So - some insurers will prefer you use the CPT codes for the bone graft at time of implant placement and the sinus augmentation, but you will also find insurers that will prefer you use the "D" codes listed above on the medical claim form when billing for these procedures! Also, some insurers may consider these procedures "Dental in Nature Oral Surgery" services, depending on their medical policies guidelines.

For example, here is a link to Aetna's medical policy titled "Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans", and include sinus lifts:
http://www.aetna.com/cpb/medical/data/1_99/0082.html

Here is another example, UHC Oxford policy titled "DENTAL AND ORAL SURGICAL PROCEDURES"
https://www.oxhp.com/secure/policy/dental_and_oral_surgical_procedures.pdf


Hope this helps, have a great day!
Mark
#3 Posted : Wednesday, February 17, 2016 1:31:45 AM(UTC)
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So would you pre-auth this irst normally. Code a 99202 for screening and any xrays and photos then preauth and see benefits? Or are you suggesting just bill as you go along? Thanks
courtneydsnow
#4 Posted : Thursday, February 18, 2016 1:06:31 PM(UTC)
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courtneydsnow

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Hi Mark!

Great question. It is usually not necessary to pre-authorize for Evaluation & Management code (office visit code), 99201-99205, 99211-99215, and 99241-99245.

However, keep in mind, if the patient has an HMO policy (or any policy with in-network benefits only) and you are an out-of-network provider, you may need to request a GAP/in-network exception before the plan will pay anything to you as an out of network provider.

But yes, after the initial evaluation it is always a great idea to do a benefit verification and inquire whether a pre-authorization is required for any planned treatment. If a pre-auth is required, of course file that and get approval before beginning to render services.

Hope this helps, have a great day!
Guest
#5 Posted : Monday, July 17, 2017 1:36:05 PM(UTC)
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Hi I need medical code for D4266

Thank you,

Claudia
courtneydsnow
#6 Posted : Thursday, July 20, 2017 6:59:50 AM(UTC)
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courtneydsnow

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Hi Claudia!

D4266 - guided tissue regeneration - resorbable barrier, per site
can be cross coded to:
41870 - Periodontal mucosal grafting

Hope this helps!
Guest
#7 Posted : Wednesday, February 28, 2018 9:49:21 AM(UTC)
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Thank you for GTR code.

Can you please give me a code for D6010,D6190,D7210,D9230,D7953 and include if you can the diagnosis code thank you so much

Claudia
courtneydsnow
#8 Posted : Thursday, March 1, 2018 8:55:17 AM(UTC)
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courtneydsnow

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Hi Claudia!

D6010
- surgical placement of implant body: endosteal implant
can be cross coded to:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3or less)
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more)


D9230 - inhalation of nitrous oxide / anxiolysis, analgesia
can be crosscoded to:
00170 - Anesthesia for intraoral procedures, including biopsy; not otherwise specified


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


D6190 - radiographic/surgical implant index, by report
D7210 - surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated

The codes listed above do not have direct crosscodes 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 try the CPT codes below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures


As for the diagnosis code(s), that will depend on why the patient is receiving the services! Basically, what is the condition/disease that is causing these services to be needed.

For example, if it is due to atrophy, here are some coding options below:

K08.21 - Minimal atrophy of the mandible
K08.22 - Moderate atrophy of the mandible
K08.23 - Severe atrophy of the mandible
K08.24 - Minimal atrophy of maxilla
K08.25 - Moderate atrophy of the maxilla
K08.26 - Severe atrophy of the maxilla

If it is something else, let me know and I am happy to offer you some coding options.

Hope this helps!
Guest
#9 Posted : Sunday, June 21, 2020 7:13:55 PM(UTC)
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I want to hire someone who can convert dental codes for a preauthorization for an upcoming surgery for 8 dental implants for a young woman who is congenitialy missing 8 teeth. There is documented medical necessity and a self insured insurance plan that has a precedent for paying on these types of cases.

PLEASE CALL (949)274-0203 IF YOU CAN BE OF ANY ASSISTANCE.

Thank you!

Tricia Lamm
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