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Courtney, your implant info is very helpful. Can you tell me, if I bill Medicare for 21249 or 21248, is it one reimbursement? In other words, if we are doing 5 implants in the mandible, does Medicare only consider one line item? It's not billed per tooth as dental would be, correct? The reimbursement seems very low for so many implants.
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Hi Guest!
D6010 - surgical placement of implant body: endosteal implant can be crosscoded 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)
D7950 - osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla - autogenous or nonautogenous, by report 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
D4266 - guided tissue regeneration - resorbable barrier, per site can be cross coded to: 41870 - Periodontal mucosal grafting
D9310 - consultation - diagnostic service provided by dentist or physician other than requesting dentist or physician Can be crosscoded to: • 99241 - Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and 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 self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family. • 99242 - Office consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and 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 severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
D7210 - surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated D6011 - second stage implant surgery D6057 - custom fabricated abutment - includes placement D6058 - abutment supported porcelain/ceramic crown
The codes listed above do 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), or you can try the CPT code below and include a narrative report describing the procedure: 41899 - Unlisted procedure, dentoalveolar structures
And yes, Y92.016 stands for: Swimming-pool in single-family (private) house or garden as the place of occurrence of the external cause
Which is a good start, that code describes where the accident happened, so you will also want codes for how the accident happened, as well as to describe the injury/damage.
For example, here are some options for the injury/damage:
If the tooth was fractured: S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
If cracked: K03.81 - Cracked tooth
If lost: 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 K08.111 - Complete loss of teeth due to trauma, class I K08.112 - Complete loss of teeth due to trauma, class II K08.113 - Complete loss of teeth due to trauma, class III K08.114 - Complete loss of teeth due to trauma, class IV K08.119 - Complete loss of teeth due to trauma, unspecified class
As for how the accident happened, here are some coding options for you: W50.0XXA - Accidental hit or strike by another person, initial encounter W50.1XXA - Accidental kick by another person, initial encounter W51.XXXA - Accidental striking against or bumped into by another person, initial encounter
As for what code to "attach" the diagnostic code to - all of them! The reason for the services is the diagnostic codes, so you will list all of the diagnostic codes you choose in box 21 of the claim form, and all of the services you performed in box 24 of the claim form. The diagnosis pointer on each line item will point to all diagnostic codes listed in box 21.
Hope this helps, have a great day!
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Hello,
I need help cross coding D6010, D7210, D7950, D4266, D9310, D6011, D6057, D6058 and a flipper.
Also, the diagnostic options for these codes.
I have a patient who was in an accident at their house where their child bumped them in the mouth while swimming in their pool. They have dental coverage through their medical for accidental dental.
I came across y92.016 for the swimming pool accident. Which code do I attach this too? D9310?
Thanks!
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