Hi, I have an urgent request for crosscoding the following dental codes and my insurance company won't give them to me or helping at all. I have a hole internally in my face from a bad root canal infection and terrible front face fall in my front tooth 10 years ago. This tooth needs to get extracted as soon as possible and out of pocket will cost $10K and I can't afford to pay that. My medical insurance said they will consider reviewing the claim if I am able to crosscode the dental codes to medical. I don't know where to begin and noone will help me. I am in terrible pain with horrible headaches and starting to feel sick everyday. Please help...

Here are the dental codes I urgently need crosscoded to medical:

D6190
D7999
D9215
D7140
D0364

D4266
D4273
D4264

D6010

Hi Guest!

Good work, your coding options look good to me! Just don't forget to use the -52 modifier for your bone grafts/sinus lifts if the bone is not harvested from the patient.

The supplemental information you selected looks great. You don't necessarily need to put both the JP/JO qualifier as well as the codes description in the supplemental information line of the claim form (although that may not be a had idea at all!) - most of the time you'll just use either the JP/JO qualifiers, or the "ZZ" description. Either way, yes you will likely need to offer a bit more explanation in your supporting documentation that will likely be requested when you submit the claim :)

And great question on the frequency of listing 41899 on the medical claim - I have not yet run into any practices that had problems listing that code multiple time to stand for different procedures. Especially when you get into restorative type services for accident cases for example - there many times are not specific CPT codes for many procedures that are covered....so if they won't take the "D" codes, then they pretty much have to let you list that code multiple times!! :)

Hope this helps!

Wow thank you so much for the kind words, and you're very welcome!

Hi Guest!

Yes correct, if the medical insurer you are filing with will not process "D" codes, then you will likely have 41899 on more than 1 line item on the claim.

A good way to differentiate the different services on the claim to make it easier for the medical insurer to identify what service 41899 is representing on each line item is to utilize the "supplemental information" line on those line items (the red shaded line of each line item that is usually left blank).

For example, if you want to put a quick narrative description of what the service is, you can enter the qualifier "ZZ", then type a short description.

Or for example, let's say you did extractions on teeth #123456&7. For services like these, you could choose to utilize the JO & JP qualifiers in the supplemental section of the line item. The JO & JP qualifiers represent tooth numbers and areas of the oral cavity for medical claims.

The following are the codes for tooth numbers, reported with the JP qualifier:
• 1 –32: Permanent dentition
• 51 –82: Permanent supernumerary dentition
• A –T: Primary dentition
• AS –TS: Primary supernumerary dentition

The following are the codes for areas of the oral cavity, reported with the JO qualifier:
• 00 : Entire oral cavity
• 01 : Maxillary arch
• 02 : Mandibular arch
• 10 : Upper right quadrant
• 20 : Upper left quadrant
• 30 : Lower left quadrant
• 40: Lower right quadrant


So, in the extraction example above - I would code 41899, and then in the supplemental information section of the line item, I would enter: JP1 2 3 4 5 6 7

Examples of how this would look on the medical claim can be found in the NUCC's CMS 1500 claim form manual here, starting on page 46 & 47:
http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v5.pdf


And yes you should always enter the fee you wish to charge in the charge per unit field on the medical claim. The insurer will not assume a fee for you based on information in a narrative report.

Hope this helps, have a great day!

Hi Guest!

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)

D6104 - bone graft at time of implant placement
can be crosscoded to:
21210 - graft, bone; nasal, maxillary, or malar areas
21215 - graft, mandibular
**use modifier -52 for reduced services when bone is not obtained from patient


D6190 - radiographic/surgical implant index, by report
D0393 - treatment simulation using 3D image volume
D6056 - prefabricated abutment - includes modification and placement
D6065 - implant supported porcelain/ceramic crown

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

Hope this helps!