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TMD Diagnosis Codes - TMD Diagnosis Codes
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jbublik
#1 Posted : Wednesday, March 2, 2016 5:54:31 PM(UTC)
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jbublik

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Joined: 10/16/2013(UTC)
Posts: 20
We have been having issues with claims for treatment of TMD coming back saying that the diagnosis code used is not a valid TMD diagnosis code. Is insurance requiring one specific code to classify as that now? I had previously attended a study session where I was given a number of TMD codes, but we've tried using ones like M26.53 and have gotten denials. Is there a different code we should be using? Thanks!
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courtneydsnow
#2 Posted : Thursday, March 3, 2016 8:24:02 AM(UTC)
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courtneydsnow

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Hi jbublik!

Great question. Below are the five ICD-10 diagnosis codes that stand for TMD's:
M26.60 - Temporomandibular joint disorder, unspecified
M26.61 - Adhesions and ankylosis of temporomandibular joint
M26.62 - Arthralgia of temporomandibular joint
M26.63 - Articular disc disorder of temporomandibular joint
M26.69 - Other specified disorders of temporomandibular joint

Some insurers will accept M26.53 which stands for: "Deviation in opening and closing of the mandible" for coverage of TMD treatment services, but many will require at least one of the TMD diagnosis codes listed above.

You can check various insurance companies medical policies online for the insurers you are working with, and many policies will list the accepted ICD-10 diagnosis codes. For example, here is a link to Aetna's general medical policy titled "Temporomandibular Disorders"
http://www.aetna.com/cpb/medical/data/1_99/0028.html
In the coding section located near the end of the policy, only the five codes mentioned above are listed for TMD diagnosis as accepted. There is also dislocation of jaw and fracture of mandible & maxilla codes listed as well.

Hope this helps, have a great day!
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