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Thank you so very much!! This has all be such a headache and I am ready to have this behind us, hopefully this is the last thing needed to be able to move forward!
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Hi MamaK!
No problem!
Staring with the diagnosis codes. Based on what you described, here are some options for you below:
First, your doctor will want to select at least one of the following to describe the trauma to the teeth/oral cavity: S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture S03.2XXA - Dislocation of tooth, initial encounter 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
Second, how the accident happened (and thank you for the details, they're very helpful!) W08.XXXA - Fall from other furniture, initial encounter W18.09XA - Striking against other object with subsequent fall, initial encounter
And possible pain codes to accompany: G89.11 - Acute pain due to trauma
Now, as for the procedure codes:
D7911 stands for: complicated suture - up to 5 cm can be crosscoded to: 40831 - Closure of laceration, vestibule of mouth; over 2.5 cm or complex
D9420 stands for: hospital or ambulatory surgical center call can be crosscoded to: 99281 - Emergency department visit (level 1) 99282 - Emergency department visit (level 2)
D0220 - intraoral - periapical first radiographic image can be cross coded to: 70300 - Radiologic examination, teeth; single view
D0230 - intraoral - periapical each additional radiographic image Can be cross coded to: 70310 - Radiologic examination, teeth; partial examination, less than full mouth
D7140 - Extraction, erupted tooth or exposed root (elevation and/or forceps removal)
There are not direct crosscodes we are aware of for extractions, so you can either use 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
D0140 - limited oral evaluation - problem focused Can be crosscoded to: 99201 - Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A 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 self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. or 99211 - Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.
Hope this helps!
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Hi all. I'm just a mom seeking some help, I hope that is ok to post here!
My daughter (she had just turned 5) pulled herself up over the back of the couch then hopped down and took a fall directly into the coffee table. The security camera in the living room caught it on camera, it's cringe worthy. Impact knocked 1 tooth out. We went to the children's hospital where she was admitted. She had some micro fractures (I believe that was the term), an area needing sutures, and they removed 3 other teeth. Dental insurance is denying the claim, even though it appears it should be covered under the accidental part, the dentist's office went to bat for us and they still shot it down. Medical says they will cover it. I have to file the claim though, which is something I've never had to do. I am trying to find the correct CPT codes to write in on the itemized bill. They also want a diagnosis code. From reading a few threads on here it seems they are specific which is why I described what happened to her. (after 3 boys everyone said a girl would be easy....hahaha!)
The CDT codes are:
7911 9420 220 230 7140 140
I would appreciate any help you are able to give. Thanks in advance!
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