Hi Guest!

Great questions. The medical claim form is called the CMS1500, the current version is version 02/12.

And yes you can submit medical claims from a dental practice! Our software and seminars are specifically designed for dental practices who submit medical claims for medically necessary procedures such as accidents, sleep apnea appliance, TMD treatment, etc. For most medical insurers, you will not need a unique ID to bill the, just your NPI number(s) and tax ID.

On a case like this, i wouldn't recommend attempt to appeal to dental, as they will want to see that you at least attempted to bill it to medical insurance first. Many medical insurance policies offer pretty good coverage for accidental injury to teeth/oral cavity.

So, what you will need is the diagnosis code(s) to describe the patient's condition/situation, the procedure codes to represent the services you provided, and your clinical notes to support the treatment. Just a heads up, if you have never completed a medical claim form before, it is not the most straightforward thing in the world! (hence the reason we exist as a company :)).

So, for the procedure codes you listed below:

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.


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


D9440- office visit - after regularly scheduled hours
Can be crosscoded to:
99050 — Services provided in the office at time other than regularly scheduled office hours, or days when the office is closed (e.g., holidays Saturday or Sunday), in addition to basic service

Or, if your office does offer regularly scheduled hours during weekends and holidays when the service took place:

99051 — Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.



D2952 - post and core in addition to crown, indirectly fabricated
D2750 - crown - porcelain fused to high noble metal
D2799 - provisional crown – further treatment or completion of diagnosis necessary prior to final impression

The codes listed above 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), or you can try the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures


Now, as for the diagnosis code(s). This will depend on the nature of the injury and how the patient fell. For example, here are some possible coding options for you based on what you described below:

For the injury:

K03.81 - Cracked tooth
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
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

For the fall:

W01.0XXA - Fall on same level from slipping, tripping and stumbling without subsequent striking against object, initial encounter
W01.10XA - Fall on same level from slipping, tripping and stumbling with subsequent striking against unspecified object, initial encounter
W01.198A - Fall on same level from slipping, tripping and stumbling with subsequent striking against other object, initial encounter
W18.00XA - Striking against unspecified object with subsequent fall, initial encounter
W18.09XA - Striking against other object with subsequent fall, initial encounter
W18.31XA - Fall on same level due to stepping on an object, initial encounter


If the above codes don't seem to fit your patient's situation, let me know some more details and I would be happy to offer you some coding options.

Hope this helps!

Haha no worries, that's always a good lesson learned in working with medical insurance - benefit check always first! :) I learned that one that hard way as well!

Yes it is certainly possible the dental insurance may offer some coverage if they are notified there is no medical coverage available to file to first.