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Hi Courtney :)
I had tooth pain, went to dentist who referred me to oral surgeon with a non restorable tooth #30. My Dental insurance didn't cover 3 of the (many) Procedure Codes, but noted they may be covered under Medical Ins.
I was told by my Medical Insurance company to complete a Medical Claim form. I took it to the Billing Manager at my Oral Surgeon's office, and she helped me fill in everything except the Diagnosis Codes. She said "we never use those for our dental claims".
I'm assuming my Medical Ins. Provider will want the Diagnosis codes on the form, so I'm asking for your help to identify it/them.
Here are the Procedure Codes used when I had #30 extracted:
D7210 - Surgical Extraction #30
D7953 - Bone graft ridge preservation #30
D7921 - Collection and application of autologous blood concentrate product
The notes on my encounter when the DMD let me know I needed to schedule to have it extracted say:
HPI:
"(pt) is referred for eval of extraction of tooth #30 w/placement of implant. They state that they had this tooth determined non restorable and were recommended for extraction."
Radiographic Exam:
"Panoramic / CBCT radiograph dated 2024 confirms clinical examination. Condyles are seated in the fossae in normal morphology, no occult pathology is noted.
Tooth #30 is carious, fractured, non restorable with apical pathology."
Assessment:
"Patient presents with carious, non restorable tooth #30"
--> What do you think (if any) Diagnosis codes should be added to each of the 3 Procedure Codes listed above?
Thank you in advance :)
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Originally Posted by: courtneydsnow  Hi Guest!
As for the CPT crosscodes for the procedures you listed:
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
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 (3 or less)
(basically, if it was 3 or less implants, you'll use 21248 instead of 21249)
D0367 - Cone beam CT capture with interpretation with field of view of both jaws, with or without cranium
There is actually not currently a specific CPT code for CBCT……the closest CPT code is: “70486 - Computed tomography, maxillofacial area; without contrast material”. Many offices have been using this for some time for CBCT, and some insurers require this code to be used for CBCT (i.e. UHC). However, some medical insurers are auditing that code when used for CBCT because the description does not specify “cone beam”.
So, “76497 - Unlisted computed tomography procedure (eg, diagnostic, interventional)” is an option to use (keep in mind you'll need to provide a narrative description for unlisted codes).
D0160 - detailed and extensive oral evaluation - problem focused, by report
can be crosscoded to one of the following Evaluation & Management (E&M) codes:
New patients:
99202 – 15-29 mins
99203 – 30-44 mins
99204 – 45-59 mins
99205 – 60-74 mins
Established patients:
99212 – 10-19 mins
99213 – 20-29 mins
99214 – 30-39 mins
99215 – 40-54 mins
D7210 - Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated
D6085 - provisional implant crown
D6051 - interim abutment
As for extractions, crowns & abutments, they do 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
As for the ICD-10 diagnosis code(s), based on what you described, here are some coding options for you to consider:
K03.81 - Cracked tooth
Y65.8 - Other specified misadventures during surgical and medical care
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Hello,
I have an accident where i required dental implants. I had the procedure done at my dental office, however, they could not bill my medical insurance because they did not have the correct codes & i had to pay almost 25k up front to get the surgery done.
These were the codes i was provided, anything with a *, i believe this could be billed to my medical.
How can i convert these codes to medical?
*D6010
*D7210
*D7953
D4266
D6057
D2740
D2950
D9944
Thanks in advance!
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Hi Rachel!
Depending on the patient's condition/situation, it is very likely that you'll use the same diagnostic codes for the D7957 as you did for the D7953 (basically, the diagnosis(es) that led to the bone graft being needed can be the same reason that the guided tissue regeneration needed to be done as well).
And just a heads up, some medical insurers will require the use of CPT codes (medical procedure codes) instead of the CDT code (dental procedure codes). If that's the case:
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
D7957 - guided tissue regeneration, edentulous area – non-resorbable barrier, per site
This code does not 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), but for the medical insurers who won't accept the "D" codes, you can try the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures
Hope this helps!
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Good morning, I have a patient that had a D7953 along with D7957 the day of the extraction to preserve to bone level for implant placement after healing. My question is that her insurance is denying due to stating it's medical and needs to be submitted that way. I had the medical insurance agent call and asked if we can convert the codes to CPT? I'm thinking we give her the CDT codes we used, along with the diagnosis codes to go along with them to submit? Looking at the past responses, we know what diagnosis code would be for D7953, but what options do I have for D7957?
Thank you,
rachel
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Hi Guest!
As for the CPT crosscodes for the procedures you listed:
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
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 (3 or less)
(basically, if it was 3 or less implants, you'll use 21248 instead of 21249)
D0367 - Cone beam CT capture with interpretation with field of view of both jaws, with or without cranium
There is actually not currently a specific CPT code for CBCT……the closest CPT code is: “70486 - Computed tomography, maxillofacial area; without contrast material”. Many offices have been using this for some time for CBCT, and some insurers require this code to be used for CBCT (i.e. UHC). However, some medical insurers are auditing that code when used for CBCT because the description does not specify “cone beam”.
So, “76497 - Unlisted computed tomography procedure (eg, diagnostic, interventional)” is an option to use (keep in mind you'll need to provide a narrative description for unlisted codes).
D0160 - detailed and extensive oral evaluation - problem focused, by report
can be crosscoded to one of the following Evaluation & Management (E&M) codes:
New patients:
99202 – 15-29 mins
99203 – 30-44 mins
99204 – 45-59 mins
99205 – 60-74 mins
Established patients:
99212 – 10-19 mins
99213 – 20-29 mins
99214 – 30-39 mins
99215 – 40-54 mins
D7210 - Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated
D6085 - provisional implant crown
D6051 - interim abutment
As for extractions, crowns & abutments, they do 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
As for the ICD-10 diagnosis code(s), based on what you described, here are some coding options for you to consider:
K03.81 - Cracked tooth
Y65.8 - Other specified misadventures during surgical and medical care
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Hello!
Patient had (2) implants on #7 & 10.
Procedure codes:
D6104
D6010
D7210
D6085
D6051
D0367
D0160
Attempting to submit to medical, need ICD10.
Backstory: Patient had ho pain/issue, xray detected fracture at root #7. Patient sent to Perio, new xray detected additional fracture also at root #10. No accident/injury, patient believes biting on xray plate may have cause damage?
Any advice?
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Hi Guest!
21215 - Graft, bone; mandible (includes obtaining graft)
**use modifier -52 for reduced services when bone is not obtained from patient
And just a quick note on the ICD code you listed, K08.21 (Minimal atrophy of the mandible)
The second character should be a number "0" instead of the letter "O".
Hope this helps!
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BCBS wants my ICD-10 Code along with the procedure code
The ICD-10 code is KO8.21
I was given a procedure code of 21215.
Can you define that procedure fo me?
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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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