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Guest
#1 Posted : Friday, April 21, 2017 11:17:44 AM(UTC)
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Hi, patient got bone grafting procedure (D7953) to get dental implant placement however his dental insurance denied saying that this procedure is a medical benefit. So, I submit the claim to his Medical Insurance.Now medical insurance is asking the diagnosis code for this treatment. There is no accident or trauma. What could be the diagnosis code for medical?

P.S.: Treating dentist is an oral surgeon

Thanks
Gina
courtneydsnow
#2 Posted : Monday, April 24, 2017 8:28:46 AM(UTC)
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Hi Gina!

Great question. The diagnosis code will depend on why the bone graft and implant are needed. Many times the diagnosis code for bone graft is atrophy, but also may be something else depending on what the patient's condition is.

For example, here are the atrophy codes 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 the bone graft and implant are being done for a different reason, let me know and I'd be happy to offer you some coding options.
Guest
#3 Posted : Tuesday, April 9, 2019 2:57:45 PM(UTC)
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Hi, I am a patient that had an implant procedure approx. 5 years ago. However in October 2018 with xray It was found that the bone around the implant deteriorating thus I needed to have this re done. As a result my dental insurance see the new bone grafting as a medical procedure but the dentist that completed the procedure does not know what diagnosis code to use can you help us. The procedure code he used was D7953
Thank you, Leslie
courtneydsnow
#4 Posted : Wednesday, April 10, 2019 10:25:49 AM(UTC)
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Hi Leslie!

Based on what you described, here are some possible diagnosis coding options:

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
M27.61 - Osseointegration failure of dental implant
M27.62 - Post-osseointegration biological failure of dental implant
M27.63 - Post-osseointegration mechanical failure of dental implant
M27.69 - Other endosseous dental implant failure


Also, for the procedure coding:
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

Hope this helps!
Guest
#5 Posted : Tuesday, October 15, 2019 2:23:01 PM(UTC)
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As a periodontist, I am interested if my patients can receive medical benefits for these items:

Cone Beam CT scans: Dental Code D0380, D0382, D0383
Intra Oral Scans: 3D Photo Image: D0351
Night Guard: Hard D9944, Soft D9945
Resorbable Membrane: D4266
Bone Graft (Guided Bone Regeneration): D7950
Open Flap Surgery: D4240 or D4241

What choices of Medical Diagnosis codes, etc could be helpful for billing?

Thank you!

Edited by user Tuesday, October 15, 2019 2:24:56 PM(UTC)  | Reason: Clarification

courtneydsnow
#6 Posted : Friday, October 18, 2019 11:40:36 AM(UTC)
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Hi Guest!

Great question. Whether or not the patient will be eligible for medical coverage/reimbursement for the services you listed will all depend on the "why" basically! Your patient's condition/diagnosis will determine if the medical insurer considers those services medically necessary or not. For example, it is not typical for a medical insurer to offer coverage for a single implant, however if it is needed due to a traumatic accident or tumor removal, it can be covered! Same with the services you listed - it's not extremely common for a medical insurer to cover just a plain night guard/occlusal guard, however if the patient is diagnosed with TMJD and the appliance is being used to treatment, many medical insurers offer coverage for that. Or, if it is an appliance being used to treat Obstructive Sleep Apnea, most medical insurers do offer coverage.

We have wonderful crosscoding seminars that we hold around the country to teach dental practices to effectively work with medical insurance for various treatments and procedures such as sleep apnea appliances, treatment for TMJD, office visits, x-rays, frenectomies, etc. Here is link to our seminar schedule, we would love to have you join us at one: https://niermanpm.com/dental-continuing-education/schedule

Hope this helps!
Guest
#7 Posted : Monday, November 4, 2019 10:25:58 AM(UTC)
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Hi, I am a patient of a dentist. I was seen for the extraction of three upper molars. Pathology resulted in the erosion and perforation of the sinus floor bilaterally resulting in extensive mucositis/sinusitis/infection. Removal of the infected teeth resulted in sinus perforation on both sides. To avoid a prolonged infection and more rapid healing the dentist performed a socket graft/oral-astral closure.
The procedure was coded to D7921 collection and application of blood and to D7953 bone replacement graft for the dentist's billing purposes. These codes are not a benefit for my dental insurance and do not work medical billing. I have submitted a claim to Medicare and they are asking for ICD.9 or ICD.10 diagnosis codes.
Do you have any suggestions for a code for medical insurance reimbursement purposes?

Thank you for any suggestions you have

Joe
courtneydsnow
#8 Posted : Monday, November 11, 2019 1:21:19 PM(UTC)
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Hi Joe!

Based on what you described below, here are some ICD-10 coding options for the condition:

J34.89 - Other specified disorders of nose and nasal sinuses
J34.81 - Nasal mucositis (ulcerative)
K12.39 - Other oral mucositis (ulcerative)

J01.00 - Acute maxillary sinusitis, unspecified
J01.01 - Acute recurrent maxillary sinusitis
J01.10 - Acute frontal sinusitis, unspecified
J01.11 - Acute recurrent frontal sinusitis
J01.20 - Acute ethmoidal sinusitis, unspecified
J01.21 - Acute recurrent ethmoidal sinusitis
J01.30 - Acute sphenoidal sinusitis, unspecified
J01.31 - Acute recurrent sphenoidal sinusitis


J32.0 - Chronic maxillary sinusitis
J32.1 - Chronic frontal sinusitis
J32.2 - Chronic ethmoidal sinusitis
J32.3 - Chronic sphenoidal sinusitis
J32.4 - Chronic pansinusitis
J32.8 - Other chronic sinusitis
J32.9 - Chronic sinusitis, unspecified


Hope this helps!
Guest
#9 Posted : Friday, April 2, 2021 4:26:52 PM(UTC)
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Hello,
I am a patient and looking to bill medical for my extractions and bone graft and sinus lift. I have gerd, Barrett’s esophagus and laryngopharyngitis reflux also. Which that effects my bone loss and why I now need graft and sinus lift. I will also need implant dentures after I heal. The placement for them. Please what codes are used to bill medical insurance.

Thank you
Jodi
Guest
#10 Posted : Thursday, April 15, 2021 10:00:38 AM(UTC)
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Hi,

I am working tirelessly to get the cost of my mom's dental implants done via prior authorization to medical.

Is this thread still active to help me go through the dental codes and cross reference them to the ICD and CPT codes
courtneydsnow
#11 Posted : Friday, April 16, 2021 7:32:51 AM(UTC)
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Hi Guest!

Yes this thread is still active.
courtneydsnow
#12 Posted : Friday, April 16, 2021 7:35:22 AM(UTC)
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Hi Jodi!

Extractions actually 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

For a sinus lift:
21210 - Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)
**use modifier -52 for reduced services when bone is not obtained from patient

For implants:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3 or less)
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more)


Hope this helps!
Guest
#13 Posted : Friday, July 9, 2021 12:11:26 AM(UTC)
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Hi Courtney!

I hope this message finds you well :)

I've been researching a ton in hopes of helping my oral surgeon and prosthodontist be able to code my medically necessary All 4 On implant surgery and implant creation and molding costs.

I have Multiple Autoimmune disease syndrome, Crohn's disease, Sjogren's Syndrome, and GERD that have caused me to have the oral health status of that of a 70-year-old and I'm only 38.

I've been getting fillings since the age of 6 due to the aggressiveness of my conditions, and as I've gotten older I've had to have very large and deep fillings placed in every tooth that I have remaining, or a root canal on many of them.

Currently, I'm having severe pain in 2 of my teeth that had root canals previously and are now broken with the gum line in between them inflamed. This issue with inflamed gums is also playing out all through my mouth and with all of my other remaining teeth with excessive bleeding as well.

Implants are necessary bc at this point I can't eat properly, and the only thing left to do for my remaining 23 teeth are extractions since my fillings are so huge and deep, and a majority already have root canals. Not to mention that with every major tooth procedure, I end up in the hospital with a Crohn's flare bc of the antibiotics and my digestive issues, or bc of the pain and stress associated with the procedures. So, getting All 4 On implants is actually preventing my health from deteriorating even further with each additional filling or root canal. Implants will handle all of my oral issues at once and provide me with a clean slate that is less likely to also endanger my health.

My treatment plan will include my oral surgeon who will handle all of the extractions and stud placement and a prosthodontist who will create and insert my temporary and permanent implants.

As you can imagine, I'm beyond frustrated with my oral situation as I've always attended the dentist and completed fillings and root canals as suggested, but now all of those fillings and root canals are too old and/or weak and need the next step of care in order to keep my health on par.

Is there any way you could guide me on the medical codes to use with my health insurance company Anthem Bluecross PPO, to have both my oral surgery or extraction of my remaining heavily damaged 23 teeth removed, and any implant preparations and fittings afterward?

Any guidance or help you can supply me with would be HUGELY appreciated, and ABSOLUTELY life-saving.
otherwise, I'm not sure that I can afford the implants even though they are clearly necessary for me to eat and function :(

Thanks SO much and please stay safe ;)

xo, Chana

Edited by user Friday, July 9, 2021 12:12:56 AM(UTC)  | Reason: Spelled name incorrectly

courtneydsnow
#14 Posted : Wednesday, July 14, 2021 9:10:14 AM(UTC)
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Hi Chana!

Here are some procedure coding options that I believe will be pertinent to your case:

Bone grafts:
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

Implants:
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more)


As for the CPT code for extractions, there is actually not 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


Your providers will definitely want to drive home the point of a functional impairment in order to your medical insurer to consider this case medical in nature instead of dental in nature.

I was able to locate Anthem BC medical policy titled "Mandibular/Maxillary (Orthognathic) Surgery", here is a link to it:
https://www.anthem.com/dam/medpolicies/abc/active/guidelines/gl_pw_d083869.html

This policy should be extremely helpful for your provider to provide the information the insurer will be looking for to meet medical necessity guidelines, likely specifically under the labels of "Dysphagia" and/or "Masticatory dysfunction or malocclusion".

I hope this helps!
Tiffany
#15 Posted : Wednesday, July 14, 2021 2:47:07 PM(UTC)
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Hi Courtney!

I work at a Periodontal office and am filing a medical claim for a patient that fractured two teeth in the result of an accident/trauma. I'm trying to find the right coding options for him as we don't generally file medical.

The Dental coding for treatment is:
9248- Non-intravenous conscious sedation, D9248?
7210- Extraction #8 - Using code S02.5XXB (root was exposed after fracture)
7210- Extraction #9 - Using code S02.5XXA
7953- Bone Replacement for ridge aug # 8- I'm not sure which codes to use for these two? Future implant placement is hopeful.
7953- Bone replacement for ridge aug #9-
4266- Guided tissue generation #8- 41870 - Periodontal mucosal graft ?
4910- Periodontal maintenance.- D4910?

Could you give some guidance? Thanks so much!
courtneydsnow
#16 Posted : Tuesday, July 20, 2021 3:31:37 PM(UTC)
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Hi Tiffany!

D9248 - non-intravenous conscious sedation
For patients 5+ years old, can be cross coded to:
99152
Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older
99153
Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; each additional 15 minutes intraservice time (list separately in addition to code for primary service)


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


D7210
- Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated
D4266 - guided tissue regeneration - resorbable barrier, per site
D4910 - periodontal maintenance

As for the CPT code for extractions, guided tissue regeneration & perio maintenance, there is actually not 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


Now, as for the ICD-10 (diagnosis) codes to use for these services, you will want a code to describe the trauma, and a code to describe the accident itself.

For fractured teeth, your coding options are:
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
S03.2XXA - Dislocation of tooth, initial encounter
G89.11 - Acute pain due to trauma

For the for code to describe the accident, if you can provide me with some details on what the accident was/how it happened, i'm happy to offer you some coding options.

Hope this helps!
Tiffany
#17 Posted : Thursday, July 22, 2021 7:47:47 AM(UTC)
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Thank you so much Courtney!

The patient was actually stung by a wasp which caused anaphylactic shock and caused him to fall in his driveway on concrete and hit face first. He broke his nose and fractured his front teeth, breaking one off in the process.
courtneydsnow
#18 Posted : Thursday, July 22, 2021 11:57:00 AM(UTC)
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Hi Tiffany!

Ok great thanks for those details! Based on what you described, it looks like you best option to describe the fall is:

W18.39XA - Other fall on same level, initial encounter

Hope this helps!
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