Hi Janie!

In order to bill Medicare for services related to an auto-accident, your doctor/practice will need to be enrolled as a Medicare Part B provider for your jurisdiction. (billing medicare for sleep apnea appliances would require that your practice enroll as a DME supplier)

Here is a fact sheet Medicare provides for more information on the enrollment process:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedEnroll_PhysOther_FactSheet_ICN903768.pdf

Here is a link to the Medicare Part B enrollment application, the 855i form:
https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855i.pdf

And as for what ICD-10 diagnosis code would be used, it all depends on the patient's condition, and the details of the accident they were involved in.

For example, if the patient experienced partial loss of teeth due to the accident, here are some ICD-10 coding options:
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

Or, for example if the patient is experiencing pain due to trauma:
G89.11 - Acute pain due to trauma
G89.21 - Chronic pain due to trauma

Or, perhaps the patient is experiencing TMD issues:
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

Now, as for the code to describe the accident, you will need more detail about the nature of the accident in order to determine the appropriate code, such as was the patient the driver or passenger, was the accident with another motor vehicle or something else, etc. Here are a few examples of accident ICD-10 codes:
V49.59XA - Passenger injured in collision with other motor vehicles in traffic accident, initial encounter
V49.59XD - Passenger injured in collision with other motor vehicles in traffic accident, subsequent encounter
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
V49.09XA - Driver injured in collision with other motor vehicles in nontraffic accident, initial encounter
V49.09XD - Driver injured in collision with other motor vehicles in nontraffic accident, subsequent encounter

Hope this helps!

Hi guest!

Here are some ICD-10 coding options for you:

For the accident:

V86.59XA - Driver of other special all-terrain or other off-road motor vehicle injured in nontraffic accident, initial encounter

V86.59XD - Driver of other special all-terrain or other off-road motor vehicle injured in nontraffic accident, subsequent encounter

V86.59XS - Driver of other special all-terrain or other off-road motor vehicle injured in nontraffic accident, sequela

For the partial loss of teeth:

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

Hope this helps, have a great day!

Hi Guest!

As for the diagnosis code(s), here are some coding options:

W21.07XA - Struck by softball, initial encounter
W21.07XD - Struck by softball, subsequent encounter
W21.07XS - Struck by softball, sequela

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

As for the procedure code for the dental 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

Hope this helps, have a great day!

Hi guest!

D6104 - bone graft at time of implant placement
can be crosscoded to:
21210 - graft, bone; nasal, maxillary, or malar areas
21215 - graft, mandibular
**use modifier -52 for reduced services when bone is not obtained from patient

D6010 - surgical placement of implant body: endosteal implant
can be crosscoded to:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3or less)
21249 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete (4 or more)


D7250 - surgical removal of residual tooth roots (cutting procedure)

The code listed above does not have 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

D9230 - inhalation of nitrous oxide / anxiolysis, analgesia
CrossCode options:
00100 - Anesthesia for procedures on salivary glands, including biopsy
00102 - Anesthesia for procedures involving plastic repair of cleft lip
00160 - Anesthesia for procedures on nose and accessory sinuses; not otherwise specified
00170 - Anesthesia for intraoral procedures, including biopsy; not otherwise specified
00172 - Anesthesia for intraoral procedures, including biopsy; repair of cleft palate
00176 - Anesthesia for intraoral procedures, including biopsy; radical surgery
00190 - Anesthesia for procedures on facial bones or skull; not otherwise specified
00192 - Anesthesia for procedures on facial bones or skull; radical surgery (including prognathism)
01999 - Unlisted anesthesia procedure(s)


As for the ICD-10 diagnosis code(s) to use, that will actually depend on the nature of the accident/fall! (there are different codes for is a patient slipped and fell, from one level to another or same level, if they her pushed, etc etc. So, if you could give me a bit more detail about how the fall happened I would be happy to help you out with some coding options.

Also - as for the injury to to the teeth/oral cavity, you'll want to assign an appropriate ICD-10 diagnosis code to represent that as well - what are we looking at there? (i.e. were teeth cracked, broken, lost (complete or partial), etc?

Hope this helps, have a great day!

Hi guest!

Here are some ICD-10 coding options for you:

S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
K03.81 - Cracked tooth
R55 - Syncope and collapse

As for the fall itself - could you give me just a bit more info so I can offer you some more specific coding options? (i.e. did the patient just fall straight to the ground, did they hit something on their way down like a sharp object, etc?)

Hi guest!

This looks like this most specific fall code available for the situation you are describing:

W19.XXXA - Unspecified fall, initial encounter

Hope this helps, have a great day!

Hi guest!

No problem I'd be happy to help you out with some coding options.

Starting off with the accident/fall code:

W01.111A - Fall on same level from slipping, tripping and stumbling with subsequent striking against power tool or machine, initial encounter

Also, for place of occurrence:

Y92.73 - Farm field as the place of occurrence of the external cause
Y92.71 - Barn as the place of occurrence of the external cause
Y92.74 - Orchard as the place of occurrence of the external cause
Y92.79 - Other farm location as the place of occurrence of the external cause

As for the broken tooth:

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
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

Hope this helps!

Hi Guest!

Great question. From my understanding, Class I, II, III & IV signify the level of compromise based on a few main categories:

Bone height, mandibular
Maxillomandibular relationship
Residual ridge morphology, maxilla
Muscle attachments


I have some additional information I would be happy to e-mail you if you would like to post your e-mail address or send me an e-mail to courtney@dentalwriter.com

Hi Guest!

No problem, here are some ICD-10 coding options for you below:

For being hit in the face with a softball:

W21.07XA - Struck by softball, initial encounter

For the damage the softball strike did (i'm not sure if you fractured, cracked or lost teeth, so listing them all for you to choose from):

S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
S02.5XXD - Fracture of tooth (traumatic), subsequent encounter for fracture with routine healing
S02.5XXG - Fracture of tooth (traumatic), subsequent encounter for fracture with delayed healing
S02.5XXK - Fracture of tooth (traumatic), subsequent encounter for fracture with nonunion
K03.81 - Cracked tooth
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


Also FYI - D06059 is not a valid code. Did you perhaps mean:
D6059 - abutment supported porcelain fused to metal crown (high noble metal)

Hope this helps, have a great day!

Hi guest!

Great question. There are other scenarios outside of accidents where an oral implant may be covered by medical insurance - for example, if the patient has a neoplasm removed, etc. Implants for cosmetic purposes are generally not covered.

Whether the tooth/teeth were lost due to trauma or other means it is the same CPT (procedure) code, 21248 or 21249. It is the ICD (diagnosis) code that will change depending on the patient's situation/condition.

If you would like to let me know what the reason the patient lost the tooth/teeth, I would be happy to provide you with some coding options.