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I am trying to get my insurance carrier to authorize my daughters implants. She has already had a bone graft (8yrs ago) and is in her second round of orthodontics before implant surgery. She will need 2 upper incisors and at least 1 lower canine. The insurance company is asking me for codes. She has not seen a surgeon yet but the orthodontist is stating this is considered cosmetic and won't be covered. My insurance rep is trying to insist me with this. I usually do ophthalmology coding but this is stumping me! She was born with a bilateral cleft in her upper gum, therefore she has missing teeth. I have no dental insurance...Help!
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest!
No problem. It is definitely possible your medical carrier will consider this case cosmetic in nature, but it depends on the insurer and the details of the condition! Here are some coding options that may help you along the way:
Implants procedure codes:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3 or less)
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more)
Diagnosis coding possibilities:
Q36.0 - Cleft lip, bilateral
K08.89 - Other specified disorders of teeth and supporting structures
K00.0 - Anodontia
Hope this helps!
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