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Hi Judy!
No problem we're happy to help as much as possible :)
Starting off with the diagnosis code you listed: K08.409 - Partial loss of teeth, unspecified cause, unspecified class
The oral surgeon may be able to assign a more specific diagnosis code (medical insurers tend to prefer the most specific diagnostic code available). Here are the other codes available in that category that based on what you described below, may be appropriate:
K08.411 - Partial loss of teeth due to trauma, class I
K08.412 - Partial loss of teeth due to trauma, class II
K08.413 - Partial loss of teeth due to trauma, class III
K08.414 - Partial loss of teeth due to trauma, class IV
K08.419 - Partial loss of teeth due to trauma, unspecified class
The insurer may also be looking for a diagnostic code describing the accident/trauma. Accident/trauma coding gets VERY specific, so if you could provide me some details about the accident/trauma I would be happy to offer you some coding options. (for example, there are different codes for if the patient slipped and fell vs being pushed, codes for vehicle accidents and falls from ladders, codes for assault and accidental injuries, etc etc).
As for the procedure codes:
The two codes you listed do seem sound:
76376 - 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image post-processing on an independent workstation
99202 - Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family
As for the implants: below are some commonly used CPT codes when billing oral implants to medical insurance:
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)
20670 - Removal of implant due to complications (superficial)
20680 - Removal of implant due to complications (deep)
21210 - graft, bone; nasal, maxillary, or malar areas
21215 - graft, mandibular
**use modifier -52 for reduced services when bone is not obtained from patient
As for the restorative work - it does depend on what all services are included, but many restorative procedures actually do not have a specific CPT code available that describes the procedures, so the provider 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 they can use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures
Hope this helps!
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Hello,
I hope you can help me with this billing issue that the oral surgeon can't seem to manage.
My son Keelan lost both of his front teeth due to trauma 10 years ago, when he was 7yo.
Keelan is now 18 and ready for his dental implants.
He had alveolar bone graft surgery 4 months ago, with a plastic surgeon, to restore his upper jaw, which had 0mm bone in some areas.
The plastic surgeon referred us to an oral surgeon for the implant surgery.
The oral surgeons office can't seem to find the codes to submit this to medical.
My insurance told me the problem is the diagnosis code, and the claim must be with medical diagnosis and medical procedure codes.
The oral surgeon used diagnosis code
K08.409 Partial loss of teeth, unspecified cause, unspecified class
76376 Cone beam scan
99202
medical codes needed
diagnosis:
2 teeth lost due to trauma
procedures:
cone beam scan
office visits
dental implant post placement
restorative work
I have maintained with my insurance that this is not a dental care situation, its a medical issue. If he doesn't have his implants soon, he will start to lose bone all over again, from the new graft.
Thank you for any help you can offer!!!
Judy
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