21110 and E0486 for sleep apnea

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For pt with sleep apnea, provider has submitted request for E0486 which has been approved. They are now asking for 21110. Would code 21110 be bundled to E0486?
 
CPT 21110 is for the placement of a fixation device such as wiring to prevent a patient's jaw from moving. Is that what your provider has documented doing?

That code is not appropriate if they're just inserting or fitting a removable device for the patient to use at night to help their sleep apnea.
 
The provider is indicating that 21110 will be a mandibular restorer/AM aligner. . Due to the protraction of mandible as a result of oral appliance for OSA, need to restore functional muscle length and habitual occlusion. AM aligner to be worn in morning after night appliance E0486
 
The provider is indicating that 21110 will be a mandibular restorer/AM aligner. . Due to the protraction of mandible as a result of oral appliance for OSA, need to restore functional muscle length and habitual occlusion. AM aligner to be worn in morning after night appliance E0486
E0486 is the code for the device. 21110 is a procedure that the provide would need to do to install a device into a patient's mouth to fixate the jaw. It's an expensive surgical procedure that would require an operative report detailing exactly what the provider did to attach the device to the teeth or jaw. The device would then be removed by the provider at a later date.

21110 is a code for professional work, not for a device. The provider can't bill this code just for telling the patient to 'wear' a device in their mouth. If the provider is giving some kind of instruction or guidance to the patient on the use of the device, they can bill an E&M code to represent that service, if appropriately documented.
 
E0486 is the code for the device. 21110 is a procedure that the provide would need to do to install a device into a patient's mouth to fixate the jaw. It's an expensive surgical procedure that would require an operative report detailing exactly what the provider did to attach the device to the teeth or jaw. The device would then be removed by the provider at a later date.

21110 is a code for professional work, not for a device. The provider can't bill this code just for telling the patient to 'wear' a device in their mouth. If the provider is giving some kind of instruction or guidance to the patient on the use of the device, they can bill an E&M code to represent that service, if appropriately documented.
Thank you Thomas for the feedback. This is very helpful. Appreciate your guidance.
 
If an orthodontist is placing the appliance EO486 - and he is authorized and credentialed to perform these services, would 21110 a professional code that should be billed by the referring physician or him? They will both eventually be at the same office, but wondering if I need to credential an ortho to bill for 21110 since he essentially does this process? New to this type of service. Can someone help me as soon as possible?
 
If an orthodontist is placing the appliance EO486 - and he is authorized and credentialed to perform these services, would 21110 a professional code that should be billed by the referring physician or him? They will both eventually be at the same office, but wondering if I need to credential an ortho to bill for 21110 since he essentially does this process? New to this type of service. Can someone help me as soon as possible?

21110 is a surgical procedure done to treat a medical condition, not a dental procedure and, as mentioned above, isn't used for the application of a removable device. 21110 is something I would expect a maxillofacial surgeon would bill, not an orthodontist.

I don't believe that most medical payers would credential an orthodontist as a medical provider - their services are usually covered under dentals plans except in cases where there is an injury to a healthy tooth, but you might want to check with specific payers.
 
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