Common Medical to Dental Procedures and Where to Find Them

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Dec 8th, 2020

With healthcare systems integrating and consolidating the delivery of care, it only makes sense to include dental procedures in order to provide total care for a patient. Dental providers are quickly picking up on utilizing medical benefits for their patients, which affords their patients better care.

There are many common dental procedures that may be billed to a patient's health plan. We have listed a few of the most common procedures being billed to a patient's medical policy. Using your crosswalks, find the CPT codes and the documentation required by the medical carrier. Once you are familiar with the sections in the CPT book, you will gain confidence in how and where the codes can be found and begin cross coding. Start with understanding there are only 6 sections you need to be familiar with, and you certainly do not need to memorize CPT codes.

For example, let's find an open procedure for a patient being seen with a dislocated temporomandibular joint. It is repaired with an open procedure. Let's walk you through the sections to get you to the final code.

Look through the six sections. We know it was a surgical procedure on the Temporomandibular joint, so we start in the surgery section. 

Once you locate the section, each section is further broken down into anatomy, so while in the surgery section, you will need to know which part of the anatomy the procedure is being done on. In this case it is the jaw, so we look under the Musculoskeletal System. 

Surgery

We also know the jaw is a part of the head, so we look under head.

Surgery
  Surgical Procedures on the Musculoskeletal System

Now you can see how the procedures are set up pertaining to the skeletal system on the head (e.g., Incision, Excision, Manipulation, Head prosthesis, Introduction, Repair, Revision and or Reconstruction).

Now the final determining factor for code selection is the approach and the most specific code. Was it an open, closed, or percutaneous procedure that was performed? 

Surgery
  Surgical Procedures on the Musculoskeletal System
    Surgical Procedures on the Head
      Fracture and/or Dislocation Procedures on the Head

There are many other procedures and disorders covered under healthcare plans. The list below outlines a few common conditions that are likely covered. It is always recommended that you verify the patient's benefits and policy coverage prior to any procedure. In addition, to ensure you receive proper reimbursement for the services you provide, always review the payer's policy for documentation and conditions required for coverage. Find-A-Code offers commercial payer policies, including Local Coverage Determinations (LCDs) and National coverage determinations (NCDs), based on the provider's Medicare jurisdiction.

• Biopsies
• Bone atrophy resulting in ill-fitting dentures
• Bone grafts
• CT scans and exams
• Consults for medically necessary procedures
• Denture-related pressure ulcers
• Endodontics due to trauma or medical conditions
• Mucositis
• Oral Cancer
• Oral Surgery
• Reconstruction: trauma or other condition
• Sinus Lifts
• Sleep Apnea Appliances
• TMJ Treatment and appliances
• Tooth Loss due to Trauma
• Tooth Loss due to a systemic condition