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My dentist originally did a root canal/temporary crown for tooth #14. During the root canal they found a small crack in the tooth so only a temporary crown was placed. Fast forward 7 months, tooth was having throbbing constant pain again so extraction (07210) was required. Dental insurance denied the bone graft (07953) and I was told to submit to my medical insurance in case they might pay. My dentist doesn't seem to know the codes to submit. Can you help? We will be doing an implant in 6 months hopefully which is also not a covered expense but at least I will have a solid tooth again.They are using 03010/06056/06060 for the implant, prefabricated abutment and porc fused base if that helps. They did tell me that I need a different crown code for it to be covered.
Thank you in advance for your help.
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Rank: Administration
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Hi Guest!
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
D0310 - sialography
Can be crosscoded to:
70380 - Radiologic examination, salivary gland for calculus
70390 - Sialography, radiological supervision and interpretation
D6056 - prefabricated abutment - includes modification and placement
D6060 - abutment supported porcelain fused to metal crown (predominantly base metal)
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 use the CPT code below and include a narrative report describing the procedure (same for extractions & crowns):
41899 - Unlisted procedure, dentoalveolar structures
Here are the CPT codes for implants:
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)
Hope this helps!
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