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Hello,
BCBS has requested that I resubmit my claim using medical codes for processing. To give you a little backstory, my husband was playing hockey and got hit in the face with a hockey puck knocking out several teeth in the process. He required oral surgery. His oral surgeon used diagnosis code: K08419 (partial loss of teeth due to trauma, unspecified class). Two separate surgeries were required because he need a bone graph in order to secure the metal screws. I believe the surgeon used CPT code: 21248 and 21085 (among others). BCBS paid for the surgeries procedures to reconstruct and repair function of six teeth.
In between the surgeries (and while my husband was healing) his dentist provided the following services:
06793 Provisional Retainer Crown on Tooth 6, Tooth 7, and Tooth 11
06253 Provisional Pontic on Tooth 8, Tooth 9, and Tooth 10.
In a subsequent visit, the dentist provided the following services:
6085 Provisional Implant Crown on Tooth 7, Tooth 8, Tooth 9, and Tooth 10.
Finally, after all the surgeries were finished, the dentist provided the following services
06058 Abut. support porc/ceram crown on Tooth 7
06058 Abut. support porc/ceram crown on Tooth 8
06058 Abut. support porc/ceram crown on Tooth 9
06058 Abut. support porc/ceram crown on Tooth 10
06057 Custom abutment, including placement on Tooth 8
06057 Custom abutment, including placement on Tooth 9
06057 Custom abutment, including placement on Tooth 10
02740 Crown, porcelain/ceramic substrate on Tooth 6
02740 Crown, porcelain/ceramic substrate on Tooth 11
06057 Custom abutment, including placement on Tooth 7
After reading other responds on this blog, I am hoping someone could help me respond to BCBS in resubmitting our claim from the dentist with the medical codes for processing.
I appreciate any and all the help I can get!
Thank you in advance!
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Rank: Guest
Joined: 9/8/2012(UTC)
Posts: 16,815
Was thanked: 16 time(s) in 15 post(s)
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Good morning,
I am trying to submit a medical claim for a dental patient of ours.
What is the CPT code for D2330? This would be the dental code we use for and endodontic access filling - anterior composite - one surface.
Your time is so appreciated,
Kirsten
EAST AURORA family dentistry
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest!
D6793 - provisional retainer crown - further treatment or completion of diagnosis necessary prior to final impression
D6253 - provisional pontic - further treatment or completion of diagnosis necessary prior to final impression
D6085 - provisional implant crown
D6058 - abutment supported porcelain/ceramic crown
D6057 - custom fabricated abutment – includes placement
D2740 - crown - porcelain/ceramic
D6057 - custom fabricated abutment – includes placement
As for CPT codes for services listed above, there is actually not direct crosscodes we are aware of, so if the medical insurers cannot accept the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), you can use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures
As for the diagnosis codes, here are some coding options to consider (your provider should select these based on the patient's condition):
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
W21.220D - Struck by ice hockey puck, subsequent encounter
W21.220S - Struck by ice hockey puck, sequela
W21.221D - Struck by field hockey puck, subsequent encounter
W21.221S - Struck by field hockey puck, sequela
Hope this helps!
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Rank: Administration
Joined: 11/21/2012(UTC)
Posts: 1,611
Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
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Hi Kirsten!
D2330 - resin-based composite - one surface, anterior
The code 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:
41899 - Unlisted procedure, dentoalveolar structures
You may also consider using the "ZZ" qualifier on the line item of the claim in the supplemental information area (which is the red shaded line on each line item in field 24 that is typically left blank) and provide a short description of what service each one is being used represent (since 41899 is an "unlisted service" code).
Hope this helps!
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