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Thread: Need Help with billing diagnostic cast for Maxillofacial surgery

  1. #1

    Default Need Help with billing diagnostic cast for Maxillofacial surgery

    AAPC: Back to School
    I bill for the oral medicine and dentistry dept in a Hospital and we are having patients sent to us by maxillofacial surgery for diagnostic casts and pan's before surgery. We can not bill the dental insurance for these procedures (and most of them don't have dental insurance anyway.)
    Pan's are only covered by dental insurance every 5 years and diagnostic cast are only covered for Orthodontics.

    So how would I bill the medical, what medical code would I use?
    Or are these part of the maxillofacial global billing?


  2. #2
    Join Date
    Apr 2007
    Bay City, Michigan


    They both should be able to be billed to the medical insurance, the panorex is 70355 as for the casts, are you making a splint for a surgery? If it is a splint you can use 21085, or you can look at the other codes in the series of 21076-21089 which are for prosthesis.

    I hope this helps, I code for 3 oral & maxillofacial surgeons and we do a wide range of services so I will help however I can.


  3. #3


    its not a splint its the cast of the mouth that they use before surgery. Same as the casts they use to do dentures.

    These are so they can see how the mouth is formed.

    Would I use the same code?


  4. #4
    Join Date
    Apr 2007
    Bay City, Michigan


    What type of surgery are they performing that they are making the casts/models?

    If they are taking models for an orthognathic case, it would be 21085.

    Let me know and I will be glad to help you find the correct code, if this doesn't help you.


  5. #5


    It would be a Lefort or cleft palate. The problem is we are not billing for the procedure just the xrays and the diag. models. So we just get the patients sent to us and we don't know what the procedure is.

    We take the pan's, take the impressions, send them out to the lab. The Lab sends them back to us, (bills us) and we forward them to the Oral Maxillofacial dept.

    Then hospital bills for the OR procedure, but not for the dental xrays or the models.

    We are a seperate department so we need to bill for the pans and models.

    When I see splints I think of things that go in the mouth to keep the teeth in place.
    These models are not used in the mouth after they are made.

    thanks for your time.

  6. #6
    Join Date
    Apr 2007
    Bay City, Michigan


    After doing more research on this and speaking with another contact. You can use D0470, on the medical form, it is more specific or if the insurance won't accept the ADA code, you can still use the 21085 with a 52 modifier.

    Hope this helps


  7. #7


    ok, thanks for all you help. I will give it shot.

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