WeisMed2015
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I'm an AAPC member, but I haven't started working on CPC because my workload is huge right now -and- there is no program for coding medically necessary "dental" procedures. So, I've been learning as I go. My issue is that the patients are counting on me and I'm hoping you guys can help me with a very specific coding case-type. The CPT codes I bill for this case-type are 21210/21215 bone graft + 21248/21249 dental implants + 21089 interim prosthesis and later 21089 final prosthesis.
Patient with diagnosed periodontal disease and history of trauma to the teeth presents with chief complaint, "I am tired of dealing with the pain. I am unable to chew my food. I have to tear my food with my hands; shredding it so that I can try to eat it. I still will choke on the food, though, because I can't chew it completely. Patient states she wore orthodontic braces while she was in her 20s. "I had to wear them for 8 years because I had it done at the dental school". Patient reports having sucked her thumb from childhood into her 20s.
Medical History Significant For: GERD; Barrett's Esophagus; Artificial Hip, 2004; Total Reconstructive Surgery On Both Feet, 2010; On-Going Ankle Pain; Difficulty Sleeping/Insomnia; Excessive Worry; Unpleasant Breath Odor; History Of Smoking.
Medications: Nexium, 40mg; Sumatriptan, As Needed;
Patient reports a stress level of MODERATE.
Dental History Significant For: History Of Tooth Loss As A Result Of Having Fallen, Cracking Her Teeth; History Of Orthodontic Therapy To Include Orthodontic Braces For A Period Of 8 Years, Performed At Dental School; Diagnosed Periodontal Disease.
Patient presents at examination with 3 maxillary teeth and 11 mandibular teeth remaining. Patient's existing fixed reconstructive prosthesis was placed when patient was in her 20s and is currently ill-fitting/defective. Patient's attestation of masticatory dysfunction with dysphagia are clinically and radiographically supported.
Diagnoses: Skeletal malocclusion. Severe deterioration of the maxillary and mandibular alveolar bone. Soft tissue damage resulting from repetitive motion trauma and irritation caused by the defective/ill-fitting prosthesis. Masticatory dysfunction. Improper diet and nutrition due to compromised masticatory function. 8mm Overjet. Deep overbite with impingement of palatal soft tissues. Supraeruption of a dentoalveolar segment resulting from lack of occlusion. Dentition is not intact: Edentulous at #1, #2, #3, #4, #5, #7, #10, #11, #12, #13, #14, #15, #16, Maxillary and #17, #18, #32, Mandibular. Severe periodontal disease. Erosion at tooth #19, #20, #21,#22, #23, #24, #25, #26, #27, #28,#29, #30, #31, Mandibular, due to GERD. Failure of previous treatment - fixed reconstructive prosthesis has failed. History of smoking, but no longer a smoker.
*** So, as you can see, this reconstructive procedure is certainly not cosmetic. The goal of the treatment is to improve the patient's physiological function. To get the services covered for the patient, I need to code the claim so that it is obvious that the treatment is to correct a physical/functional or physiological impairment to patient's performance of basic life functions.
Insurance plans have indicated that reconstructive procedures are considered medically necessary when both SKELETAL DEFORMITY and FUNCTIONAL IMPAIRMENT criteria are met.
Facial Skeletal Deformity - Anteroposterior Discrepancies; Vertical Discrepancies; Transverse Discrepancies; Asymmetries;..
That's EVERYTHING I KNOW ;-) .... Can you help me figure out code priority so I can win this claim battle for this patient and so many others? And, by the way, I need the codes in ICD9....
And... what codes are meant to be used 1st on the medical claim? Late Effect Codes or Disorder of Bone, for instance... which should I place 1st knowing that the 1st code "drives the claim" and I don't want my claim automatically kicked out as DENTAL...
Thanks to any and all who offer advice on this!!!
Patient with diagnosed periodontal disease and history of trauma to the teeth presents with chief complaint, "I am tired of dealing with the pain. I am unable to chew my food. I have to tear my food with my hands; shredding it so that I can try to eat it. I still will choke on the food, though, because I can't chew it completely. Patient states she wore orthodontic braces while she was in her 20s. "I had to wear them for 8 years because I had it done at the dental school". Patient reports having sucked her thumb from childhood into her 20s.
Medical History Significant For: GERD; Barrett's Esophagus; Artificial Hip, 2004; Total Reconstructive Surgery On Both Feet, 2010; On-Going Ankle Pain; Difficulty Sleeping/Insomnia; Excessive Worry; Unpleasant Breath Odor; History Of Smoking.
Medications: Nexium, 40mg; Sumatriptan, As Needed;
Patient reports a stress level of MODERATE.
Dental History Significant For: History Of Tooth Loss As A Result Of Having Fallen, Cracking Her Teeth; History Of Orthodontic Therapy To Include Orthodontic Braces For A Period Of 8 Years, Performed At Dental School; Diagnosed Periodontal Disease.
Patient presents at examination with 3 maxillary teeth and 11 mandibular teeth remaining. Patient's existing fixed reconstructive prosthesis was placed when patient was in her 20s and is currently ill-fitting/defective. Patient's attestation of masticatory dysfunction with dysphagia are clinically and radiographically supported.
Diagnoses: Skeletal malocclusion. Severe deterioration of the maxillary and mandibular alveolar bone. Soft tissue damage resulting from repetitive motion trauma and irritation caused by the defective/ill-fitting prosthesis. Masticatory dysfunction. Improper diet and nutrition due to compromised masticatory function. 8mm Overjet. Deep overbite with impingement of palatal soft tissues. Supraeruption of a dentoalveolar segment resulting from lack of occlusion. Dentition is not intact: Edentulous at #1, #2, #3, #4, #5, #7, #10, #11, #12, #13, #14, #15, #16, Maxillary and #17, #18, #32, Mandibular. Severe periodontal disease. Erosion at tooth #19, #20, #21,#22, #23, #24, #25, #26, #27, #28,#29, #30, #31, Mandibular, due to GERD. Failure of previous treatment - fixed reconstructive prosthesis has failed. History of smoking, but no longer a smoker.
*** So, as you can see, this reconstructive procedure is certainly not cosmetic. The goal of the treatment is to improve the patient's physiological function. To get the services covered for the patient, I need to code the claim so that it is obvious that the treatment is to correct a physical/functional or physiological impairment to patient's performance of basic life functions.
Insurance plans have indicated that reconstructive procedures are considered medically necessary when both SKELETAL DEFORMITY and FUNCTIONAL IMPAIRMENT criteria are met.
Facial Skeletal Deformity - Anteroposterior Discrepancies; Vertical Discrepancies; Transverse Discrepancies; Asymmetries;..
That's EVERYTHING I KNOW ;-) .... Can you help me figure out code priority so I can win this claim battle for this patient and so many others? And, by the way, I need the codes in ICD9....
And... what codes are meant to be used 1st on the medical claim? Late Effect Codes or Disorder of Bone, for instance... which should I place 1st knowing that the 1st code "drives the claim" and I don't want my claim automatically kicked out as DENTAL...
Thanks to any and all who offer advice on this!!!