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We are making an appliance for our patient for treatment of TMJ, subsequent to D7880, which she has had for 5 months and has treated her symptoms significantly and successfuly. We are now at Phase 2 of her treatment, so she needs to graduate to an appliance that is wearable for her lifetime, while still keeping her symptoms from resurfacing. What would the dental and medical code be? We have the dental as D5214 currently, however, no coordinating crosscode is available.
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Hi jbublik!
Great question....to clarify for everyone - D5214 (partial utilized in the mandible) and D7880 (occlusal orthotic appliance).
If the appliance that you are making for the patient is being used to reposition the mandible to treat TMD, many insurers list code S8262 (Mandibular orthopedic repositioning device, each)in their medical policies as the treatment code. Some medical insurers will even list D7880 as an acceptable code to use.
The appliance you are making this patient, is it a fixed non-removable appliance, a removable appliance, or a partial denture? It is a maxillary or mandibular appliance?
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The appliance we are making is a removable mandibular that covers some of the existing teeth. It will not REPLACE any teeth.
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Oh gotcha - in that case it sounds like S8262 would be the most appropriate medical code to represent the TMD appliance!
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Is there a code for billing out TMJ appliance adjustments or follow up appointments?
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Hi Guest! Great question! Most offices will bill out follow up adjustment appointment using the E&M coding set for established patients (CPT codes 99211 through 99215). For more information on these codes and the required documentation - here is a link to our Tip of the Week that goes into more detail!: https://www.dentalwriter.com/forum/default.aspx?g=posts&t=308Some offices will instead choose to use code 97762 to code these follow up visits, which stands for: Checkout for orthotic/prosthetic use, established patient, each 15 minutes (so you would bill 1 unit of this code for each 15 minute spent with the patient) If you do any imaging (i.e. pano) - there are CPT codes to use for those services as well. Hope this helps! Please feel free to contact us with any further questions!
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Thank you very much. That definitely helps. Do you know of an appropriate fee other offices are billing to insurances? Or a fee range?
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Hi Guest!
The fee will definitely depend on what level of office visit is performed. Since Medicare's fee schedule is public, we can take a look at those as an example!
These amounts will vary depending on the state/location of course, but here is what we see for Texas Medicare Part B:
New patient office visits:
- 99201 - $41.01 allowed
- 99202 - $70.80 allowed
- 99203 - $102.90 allowed
- 99204 - $158.78 allowed
- 99205 - $198.27 allowed
Established patient office visits (follow ups):
- 99211 - $18.88 allowed
- 99212 - $41.33 allowed
- 99213 - $69.61 allowed
- 99214 - $102.92 allowed
- 99215 - $138.12 allowed
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