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A patient hit a dog while riding his bicycle. He suffered a concussion, an implant crown was knocked out and patient has some loose teeth.
What code do you use for the implant crown and abutment?
Is V10.0XXA correct code to use for this situation?
Do you have to have a GAP request with this type of situation?
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Hi Guest!
Great questions. Yes V10.0XXA (Pedal cycle driver injured in collision with pedestrian or animal in nontraffic accident, initial encounter)sounds like an appropriate option for the situation you described. Here are some other options just in case they apply!
- V10.3XXA - Person boarding or alighting a pedal cycle injured in collision with pedestrian or animal, initial encounter
- V10.4XXA - Pedal cycle driver injured in collision with pedestrian or animal in traffic accident, initial encounter
- S03.2XXA - Dislocation of tooth, initial encounter
- M26.34 - Vertical displacement of fully erupted tooth or teeth
- M26.33 - Horizontal displacement of fully erupted tooth or teeth
- K08.531 - Fractured dental restorative material with loss of material
- K08.530 - Fractured dental restorative material without loss of material
As for the implant crown and abutment, there is not currently a CPT we are aware of for these procedures, 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 may consider the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures
It is probably unlikely that a gap exception would be available for these types of services, as there is very likely another provider within a reasonable distance who can perform these procedures that is in-network - but it is always worth a shot to ask when you call to check the patient's benefits!
Hope this helps!
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Rank: Guest
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