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Hi there, my dentist wants me to prior authorize an implant on 7 for a young adult who has born with cleft palate. Patient has had many surgeries to correct the condition. I can visually see it is a unilateral lip, mom explained the surgery so it sounds like both soft and hard palate. I know the code for implant is 21248 would I prior authorize the abutment and crown too? If so what is the codes for those and which diagnosis code would I use for the cleft palate?
Thank you for your help!
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Hi Cindy!
Yes it would be a good idea to include the abutment and crown on the pre-auth. However, there is not a specific CPT code available for those, so you would either use the "D" code on the pre-auth (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 code for cleft palate, here is are some coding options for you:
Q35.1 - Cleft hard palate
Q35.3 - Cleft soft palate
Q35.5 - Cleft hard palate with cleft soft palate
Q35.7 - Cleft uvula
Q35.9 - Cleft palate, unspecified
Hope this helps!
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