Good evening!

I am trying to help my dad find out what the insurance will cover for his upcoming oral surgery. Since the dentist is out-of-network and does not accept any insurance, we have to submit a pre-treatment estimate request ourselves.

He is doing the mandibular arch this time and after the complete extraction of 8 remaining teeth, will have 4 implants and a bone graft, plus the immediate temporary denture.

I have the codes and tooth #s for the extractions and denture.

What I am unsure of is to what degree I need to specify the location of the implants. The implants are to secure the permanent denture that will be made about a year later, so I doubt that identifying four tooth #s makes any sense.

Do I just put '20' and '40' associated with each pair of implants? or '02' on all four? Or something else?

And regarding the bone graft procedure, is there any location indication required for this?

Thank you in advance for any advice!

Hi Guest!

Yes using the JO & JP qualifiers can certainly help your case when identifying tooth numbers and areas of the oral cavity when billing these procedures to medical insurance.

For the extractions, using the JP qualifier and indicating the tooth numbers being extracted would be a good idea.

For the bone grafts and implants, since there won't be any teeth there anymore, using the JO qualifiers would be good to indicate the area of the oral cavity those services will take place.
If it is the entire mandibular arch, you could use the qualifier "JO02" instead of using "JO30 40"

The following are the codes for tooth numbers, reported with the JP qualifier:
• 1 –32: Permanent dentition
• 51 –82: Permanent supernumerary dentition
• A –T: Primary dentition
• AS –TS: Primary supernumerary dentition

The following are the codes for areas of the oral cavity, reported with the JO qualifier:
• 00 : Entire oral cavity
• 01 : Maxillary arch
• 02 : Mandibular arch
• 10 : Upper right quadrant
• 20 : Upper left quadrant
• 30 : Lower left quadrant
• 40: Lower right quadrant

Examples of how this would look on the medical claim can be found in the NUCC's CMS 1500 claim form manual here, starting on page 46 & 47:
http://www.nucc.org/imag...on_manual_2012_02-v4.pdf

Hope this helps!