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shemen9
#1 Posted : Thursday, February 18, 2016 6:28:30 PM(UTC)
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shemen9

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Hello,

What codes do I use for the implant & implant crown on a patient that lost his #9 tooth due to an auto accident a couple of years ago? I am sending a pre-authorization to BCBS.

Thanks!
courtneydsnow
#2 Posted : Monday, February 22, 2016 11:29:28 AM(UTC)
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courtneydsnow

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Hi shemen9!

Here are the codes for implants:

21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete

As for the crown, there is not 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

As for the ICD-10 code to use for the accident, there are many, many codes available depending on the nature of the accident (for example, there are different codes depending on whether the patient was the driver or passenger, what type of vehicle they were in or hit, or possibly if they didn't hit another vehicle but crashed into something else, etc). Here are a few examples below:

V49.49XA - Driver injured in collision with other motor vehicles in traffic accident, initial encounter
V49.49XD - Driver injured in collision with other motor vehicles in traffic accident, subsequent encounter
V49.49XS - Driver injured in collision with other motor vehicles in traffic accident, sequela
V49.19XA - Passenger injured in collision with other motor vehicles in nontraffic accident, initial encounter
V49.19XD - Passenger injured in collision with other motor vehicles in nontraffic accident, subsequent encounter
V49.19XS - Passenger injured in collision with other motor vehicles in nontraffic accident, sequela
V29.9XXA - Motorcycle rider (driver) (passenger) injured in unspecified traffic accident, initial encounter
V29.9XXD - Motorcycle rider (driver) (passenger) injured in unspecified traffic accident, subsequent encounter
V29.9XXS - Motorcycle rider (driver) (passenger) injured in unspecified traffic accident, sequela
V30.0XXA - Driver of three-wheeled motor vehicle injured in collision with pedestrian or animal in nontraffic accident, initial encounter

And so on and so forth :) If you have more details about the accident, I am happy to see if we can help you find a specific code for that type of accident.



For example, here is a link to Aetna's medical policy that states:
"Most of Aetna's traditional medical plans do cover replacement of teeth as a result of a non-biting injury. These plans do cover the replacement of teeth whether accomplished by fixed or removable prostheses or by surgical placement of a dental implant body. In situations where replacement of the tooth/teeth is accomplished by dental implants, the dental crown is also a covered medical expense."

Here is a link to the full policy titled "Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans"
http://www.aetna.com/cpb/medical/data/1_99/0082.html

Hope this helps, have a great day!
 1 user thanked courtneydsnow for this useful post.
shemen9 on 2/22/2016(UTC)
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