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Question Sleep Bruxism Appliances Therapy - Question on Correct Coding
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Dr Ken Luco
#1 Posted : Friday, March 25, 2016 10:37:27 AM(UTC)
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Hello,
Can you please tell me the most appropriate coding for treatment of sleep bruxism? This is a removable dual arch appliance worn only at night. D7880 looks like a possibility, but with dual arch appliances, this coverage is for only one.

Dual arch sleep bruxism appliances are starting to emerge in the dental field and coding is a real puzzle.

The difference ICD-10 coding from regular bruxism appliances appears to place sleep bruxism under medical treatment:

Bruxism:
ICD-10-CM Diagnosis Codes >
Mental, Behavioral and Neurodevelopmental disorders F01-F99 >
Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders F40-F48 >
Somatoform disorders F45-F45.8 Bruxism

Sleep Bruxism:
ICD-10-CM Diagnosis Codes >
Diseases of the nervous system G00-G99 >
Episodic and paroxysmal disorders G40-G47 >
Sleep disorders G47-

Any assistance is greatly appreciated!
K

Edited by user Friday, March 25, 2016 12:34:24 PM(UTC)  | Reason: Additional information entered
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courtneydsnow
#2 Posted : Monday, March 28, 2016 11:51:34 AM(UTC)
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courtneydsnow

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Hi Dr. Ken Luco!

Great questions. Currently, I don't believe there are many (if any) medical insurers that will consider treatment of sleep bruxism medically necessary and offer coverage for the treatment.

There are a few medical insurers that will offer coverage for botox for treatment of "painful bruxism". For example, here is a link to Aetna’s medical policy for botox:
http://www.aetna.com/cpb/medical/data/100_199/0113.html

The above policy states:
“OnabotulinumtoxinA (Botox Brand of Botulinum Toxin Type A): Aetna considers onabotulinumtoxinA (Botox) medically necessary for any of the following conditions:
……
V. Painful bruxism”

As far as an ICD-10 diagnosis code for sleep bruxism, there is a specific one for that!

G47.63 - Sleep related bruxism

And as you mentioned below, if is daytime bruxism and not sleep related, the appropriate code seems to be:
F45.8 - Other somatoform disorders

Hope this helps, have a great day!
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