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Guest
#1 Posted : Monday, March 5, 2018 1:31:11 PM(UTC)
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Guest

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My son fell in the street and lost his front adult tooth. We took him to the ER and they put the tooth back in. However, an abscess formed and the endodontist had to perform a root canal.

I have submitted the invoice with a claim form to the medical insurance, which of course is asking for CPT codes and Diagnostic codes.

On the invoice, I have the following codes:
- 140
- 3310
- 2950
- 220
- 9230

Per your previous Q&As I understand that I should precede those codes by the letter "D" and if this doesn't work, I should put 41899 CPT code and add a summary of incident. But the insurance is also asking for a diagnostic code (3-7 characters long with a "period" somewhere in the code - per the insurance instruction). Where I can find this code?

Thank you for your help.

Edited by user Monday, March 5, 2018 1:33:09 PM(UTC)  | Reason: changed 307 to 3-7

courtneydsnow
#2 Posted : Tuesday, March 6, 2018 10:01:31 AM(UTC)
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courtneydsnow

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Hi Guest!

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


D9230 - inhalation of nitrous oxide / anxiolysis, analgesia
can be crosscoded to:
00170 - Anesthesia for intraoral procedures, including biopsy; not otherwise specified


Then yes, as you mentioned, as for these two codes below:

D3310 - endodontic therapy anterior tooth (excluding final restoration)
D2950 - core buildup, including any pins when required

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 codes below:
41899 - Unlisted procedure, dentoalveolar structures

Since it is an "unlisted procedure" code, you will want to include an explanation as to what the code is being used for. Clinical notes from your dentist would be extremely helpful for this.

Now, as for the diagnosis code(s). You will certainly want to run these by your dentist/doctor as I am not a doctor and have never seen the patient - you may even find some of these on the report from the ER ....... but based on what you described below, here are some possible ICD-10 diagnosis coding options:

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
K12.2 - Cellulitis and abscess of mouth

Now, as far as the code to represent the fall - it depends on how the fall happened and if he hit anything on the way down and things like that (or if we have pushed, slipped on ice, etc), but here are a few examples:

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


Hope this helps!



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