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Hi!
Patient had infection under a bridge and the teeth were extracted. she had no bone for implant so sinus lift was performed. What code for sinus lift and bone graft should be submitted to Blue Cross medical and under what explanation? I heard the codes change every year, and we sent the claim with the old codes and they denies because the old codes are for another procedure now!!
Thank you very much
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Hi guest! It does not appear there are CPT codes for this procedure. The policies I find keep listing the HCPCS codes: D7952 = Sinus Augmentation Via a Vertical Approach D7951 = Sinus augmentation with bone or bone substitutes via a lateral open approach Here is a link to Aetna’s medical policy titled “Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans”: http://www.aetna.com/cpb/medical/data/1_99/0082.htmlIn the policy, sinus lift surgery is listed as non-covered under the medical plan. However, it does appear there is coverage under some dental plans for it for certain indications. For example, here is a link to the UHC’s Dental Clinical Policy Titled: “ORAL SURGERY: MISCELLANEOUS SURGICAL PROCEDURES”: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Main%20Menu/Tools%20&%20Resources/Policies%20and%20Protocols/Dental%20Clinical%20Policies%20&%20Coverage%20Guidelines/StaticFiles_PDFs/Oral%20Surgery_Miscellaneous.pdf Hope this helps, have a great day!
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There can be several reasons why the amount of bone found in a patient's upper jawbone might be insufficient to accommodate a Dental Implant. They include damage to the bone due to a previous surgical procedure (like a difficult tooth extraction) or the effects of periodontal (gum) disease. A frequent problem simply involves the situation where the size and shape of their maxillary sinus is relatively large in comparison to the size of their upper jaw (as shown in our illustration above). And because of this there is not enough bone thickness in which to embed a implant.
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