I am trying to bill Cigna MEDICAL for dental work done on an epileptic patient. Due to previous seizures causing clinching of jaws, teeth and jaw have been damaged. Billing for removal of 8 teeth (D7210) Surgical removal of residual tooth root X 2 (D7250) Surgical Placement of implant X 4 (D6010) and Bone replacement graft ridge X 4 (D7953).
Can you give me crosswalk CPT codes for these and what dx codes would be best used in order to get this claim paid by the medical insurance?

Thank you so very much!

Edited by user Tuesday, July 10, 2018 11:16:11 PM(UTC)  | Reason: left out a word

Hi swillard09!


D6010 - surgical placement of implant body: endosteal implant
can be cross coded 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)

D7953 - bone replacement graft for ridge preservation - per site
Can be cross coded to:
21210 - Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)
21215 - Graft, bone; mandible (includes obtaining graft)
**use modifier -52 for reduced services when bone is not obtained from patient



D7210 - surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated
D7250 - surgical removal of residual tooth roots (cutting procedure)

The codes listed above do 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


As for the diagnosis code(s) to use - based on what you described, here are some ICD-10 coding options for you:

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
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture
S03.2XXA - Dislocation of tooth, initial encounter
Z86.69 - Personal history of other diseases of the nervous system and sense organs

When you say the jaws have been damaged - could you be more specific? I.e. fractures, etc.

Hope this helps!