May be a Payable Code for Dental Procedures under Medical Policy

by  Christine Taxin, President - Links2Success
May 25th, 2016

The following list may be payable Codes for Dental Procedures under a patients Medical Policy.  Be sure to verify with the payer for benefit coverage and exclusions.  

ICD-10-CM Diagnosis Codes

B00.2       Herpesviral gingivostomatitis and pharyngotonsilitis

K00.0       Andontia

K00.1       Supernumerary Tooth

K00.2       Abnormalites of size and form of tooth

K00.3       Mottled Teeth

K00.4       Disturbances in tooth formation

K00.5       Hereditary disturbances in tooth structure, NEC

K00.6       Disturbances in tooth eruption

K01.0       Embedded Teeth

K01.1       Impacted Teeth

K00.7       Teething Syndrome

K00.9       Disorder of tooth development, unspecified

K02.63     Dental Caries on smooth surface penetrating into pulp

K03.0       Excessive attrition of teeth

K03.2       Erosion of teeth

K03.4       Hypercementosis

K03.5       Ankylosis of teeth

K04.0       Pulpitis

K04.1       Necrosis of pulp

K04.7       Periapical abscess without sinus

K04.5       Chronic apical periodontitis

K04.6       Periapical abscess with sinus

M26.19    Other specified anomalies of jaw-cranial base relationship

M26.30    Unsp. Anomaly of tooth position of fully erupted teeth/tooth

M26.33    Horizontal displacement of fully erupted tooth or teeth

M26.35    Rotation of fully erupted tooth or teeth

M26.39    Oth anomalies of tooth position of fully erupted tooth/teeth

K08.419   Partial loss of teeth due to trauma, unspecified class

K08.530   Fractured dental restorative material w/o loss of material

K08.531   Fractured demtal restorative material with loss of material

K11.3       Abscess of salivary gland

K12.0       Recurrent oral aphthae

K14.0       Glossitis

L92.3       Foreign body granuloma of the skin and subcutaneous tissue

M12.58    Traumatic arthropathy, other specified site

M54.2      Cervicalgia

M62.40    Contracture of muscle, unspecified site

M62.838  Other muscle spasm

M62.89    Other specified disorders of muscle

M79.5      Residual foreign body in soft tissue

R60.0       Localized edema

R60.1       Generalized edema

R60.9       Edema, unspecified

G44.1      Vascular headache, not elsewhere classified

R51          Headache

R06.5       Mouth breathing

R06.7       Sneezing

R06.89     Other abnormalities of breathing

R13.10     Dysphagia, unspecified

R19.6       Halitosis

S03.0XXA Dislocation of jaw initial encounter

S01.409A Unsp open wound of unsp cheek and TMJ area, Init

T14.90     Injury, unspecified

S03.4XXA Sprain of jaw, initial encounter

S09.93XA Unspecified injury of face, initial encounter

S01.501A Unspecified open wound of lip, initial encounter

S01.80XA Unspecified open wound of other part of head initial encounter

S01.521A Laceration with foreign body of lip, initial encounter

S01.422A Laceration w foreign body of left cheek and TMJ area, init

S01.82XA Laceration w foreign body other part of head, init encntr

S01.502AUnspecified open wound of oral cavity, initial encounter

S01.512A Laceration without foreign body of oral cavity, init encntr

S02.5XXA Fracture of tooth (traumatic), init for close fx

S02.5XXB Fracture of tooth (traumatic) init encntr for open fx

S01.522A Laceration with foreign object of oral cavity, init enctr

S02.0XXS Fracture of vault of skull, sequela

S02.10XS Unspecified fracture of base of skull, sequela

S02.110S Type 1 occipital condyle fx, sequela

S02.111S Type 2 occipital condyle fx, sequela

S02.112S Type 3 occipital condyle fx, sequela

S02.113S Unspecified occipital condyle fx, sequela

S02.118S Other fx of occiput, sequela

S02.119S Unspecified fx of occiput, sequela

S02.19XS Other fx of base of skull, sequela

S02.2XXS Fracture of nasal bones, sequela

S02.3XXS Fracture of orbital floor

S02.400S Malar fracture unspecified, sequela

S02.401S Maxillary fracture, unspecified, sequela

S02.402S Zygomatic fracture, unspecified, sequela

S02.411S LeFort 1 fracture, sequela

S02.412S LeFort 2 fracture, sequela

S02.413S LeFort 3 fracture, sequela

S02.42XS Fracture alveolus of maxilla, sequela

S02.600S Fracture of unspecified part of body of mandible, sequela

S02.609S Fracture of mandible, unspecified, sequela

S02.61XS Fracture of condylar process mandible, sequela

S02.62XS Fracture of subcondylar process of mandible, sequela

S02.63XS Fracture of coronoid process of mandible, sequela

S02.64XS Fracture of ramus of mandible, sequela

S02.65XS Fracture of angle of mandible, sequela

S02.66XS Fracture of symphasis of mandible, sequela

S02.67XS Fracture of alveolus of mandible, sequela

S02.69XS Fracture of mandible of other specified site, sequela

S02.8XXS Fractures of other specified skull and facial bones, sequela

S02.91XS Unspecified fracture of skull, sequela

S02.92XS Unspecified fracture of facial bones, sequela

M84.40XSPathological fracture, unspecified site, sequela

M84.48XSPathological fracture, other site, sequela

S03.0XXS Dislocation of jaw, sequela

S13.20XS Dislocation of unspecified parts of neck, sequela

S23.20XS Dislocation of unspecified part of thorax, sequela

S33.30XS Dislocation of unsp parts of lumbar spine & pelvis, sequela

 

S43.306S Dislocation of unsp parts of unsp shoulder girdle, sequela

S63.006S Unsp dislocation of unspecified wrist and hand, sequela

S73.006S Unspecified dislocation of unspecified hip, sequela

S83.006S Unspecified dislocation of unspecified patella, sequela

S83.106S Unspecified dislocation of unspecified knee, sequela

S93.06XS Dislocation of unspecified ankle joint, sequela

S93.306S Unspecified dislocation of unspecified foot, sequela

S03.9XXS Sprain of joints and ligaments of unsp parts of head, sqla

S13.9XXS Sprain of joints and ligaments of unsp parts of neck, sqla

S23.9XXS Sprain of unspecified parts of thorax, sequela

S33.9XXS Sprain of unsp parts of lumbar spine and pelvis, sequela

S43.90XS Sprain of unsp parts of unspecified shoulder girdle, sequela

S46.919S Strain unsp musc/fasc/tend at shldr/up arm, unsp arm, sqla

S53.499S Other sprain of unspecified elbow, sequela

S56.919S Strain unsp musc/fasc/tend at forarm lv, unsp arm, sequela

S63.90XS Sprain of unsp part of unspecified wrist and hand, sequela

S66.919S Strain unsp musc/fasc/tend at wrs/hnd lv, unsp hand, sequela

S73.109S Unspecified sprain of unspecified hip, sequela

S76.919S Strain unsp musc/fasc/tend at thi lev, unsp thigh, sequela

S83.209S Unsp tear of unsp mensc, current injury, unsp knee, sequela

S83.90XS Sprain of unspecified site of unspecified knee, sequela

S93.609S Unspecified sprain of unspecified foot, sequela

S96.919S Strain of unsp msl/tnd at ank/ft level, unsp foot, sequela

S01.90XS Unspecified open wound of unspecified part of head, sequela

S11.90XS Unspecified open wound of unspecified part of neck, sequela

S21.90XS Unsp open wound of unspecified part of thorax, sequela

S31.000S Unsp opn wnd low back and pelv w/o penet retroperiton, sqla

S31.109S Unsp opn wnd abd wall, unsp q w/o penet perit cav, sequela

S00.93XS Contusion of unspecified part of head, sequela

S10.93XS Contusion of unspecified part of neck, sequela

S20.20XS Contusion of thorax, unspecified, sequela

S30.0XXS Contusion of lower back and pelvis, sequela

S30.1XXS Contusion of abdominal wall, sequela

S30.201S Contusion of unsp external genital organ, male, sequela

S30.202S Contusion of unsp external genital organ, female, sequela

S40.029S Contusion of unspecified upper arm, sequela

S50.00XS Contusion of unspecified elbow, sequela

S50.10XS Contusion of unspecified forearm, sequela

S60.219S Contusion of unspecified wrist, sequela

S60.229S Contusion of unspecified hand, sequela

S70.00XS Contusion of unspecified hip, sequela

S70.10XS Contusion of unspecified thigh, sequela

S80.00XS Contusion of unspecified knee, sequela

S80.10XS Contusion of unspecified lower leg, sequela

S90.00XS Contusion of unspecified ankle, sequela

S90.30XS Contusion of unspecified foot, sequela

S07.9XXS Crushing injury of head, part unspecified, sequela

S17.9XXS Crushing injury of neck, part unspecified, sequela

S28.0XXS Crushed chest, sequela

S38.001S Crushing inj unsp external genital organs, male, sequela

S38.002S Crushing inj unsp external genital organs, female, sequela

S38.1XXS Crushing injury of abdomen, lower back, and pelvis, sequela

S47.9XXS Crushing injury of shoulder and upper arm, unsp arm, sequela

S57.00XS Crushing injury of unspecified elbow, sequela

S57.80XS Crushing injury of unspecified forearm, sequela

S67.90XS Crush inj unsp part(s) of unsp wrist, hand and fngr, sequela

S77.00XS Crushing injury of unspecified hip, sequela

S77.10XS Crushing injury of unspecified thigh, sequela

S87.00XS Crushing injury of unspecified knee, sequela

S87.80XS Crushing injury of unspecified lower leg, sequela

S97.00XS Crushing injury of unspecified ankle, sequela

S97.80XS Crushing injury of unspecified foot, sequela

T79.9XXS Unspecified early complication of trauma, sequela

S09.90XS Unspecified injury of head, sequela

S16.9XXS Unsp injury of musc/fasc/tend at neck level, sequela

S29.9XXS Unspecified injury of thorax, sequela

S39.91XS Unspecified injury of abdomen, sequela

S39.92XS Unspecified injury of lower back, sequela

S39.93XS Unspecified injury of pelvis, sequela

S39.94XS Unspecified injury of external genitals, sequela

S49.90XS Unsp injury of shoulder and upper arm, unsp arm, sequela

S59.909S Unspecified injury of unspecified elbow, sequela

S69.90XS Unsp injury of unsp wrist, hand and finger(s), sequela

S79.919S Unspecified injury of unspecified hip, sequela

S79.929S Unspecified injury of unspecified thigh, sequela

S89.90X   SUnspecified injury of unspecified lower leg, sequela

S99.919S Unspecified injury of unspecified ankle, sequela

S99.929S Unspecified injury of unspecified foot, sequela

T88.9XXS Complication of surgical and medical care, unsp, sequela

S00.01XA Abrasion of scalp, initial encounter

S00.31XA Abrasion of nose, initial encounter

S00.419A Abrasion of unspecified ear, initial encounter

S00.511A Abrasion of lip, initial encounter

S00.512A Abrasion of oral cavity, initial encounter

S00.91XA Abrasion of unspecified part of head, initial encounter

S10.11XA Abrasion of throat, initial encounter

S10.91XA Abrasion of unspecified part of neck, initial encounter

L08.89     Oth local infections of the skin and subcutaneous tissue

S00.90XA Unsp superficial injury of unsp part of head, init encntr

S10.90XA Unsp superficial injury of unsp part of neck, init encntr

S07.0XXA Crushing injury of face, initial encounter

S07.8XXA Crushing injury of other parts of head, initial encounter

T18.0XXA Foreign body in mouth, initial encounter

T79.8XXA Other early complications of trauma, initial encounter

S09.8XXA Other specified injuries of head, initial encounter

S09.90XA Unspecified injury of head, initial encounter

T74.12XA Child physical abuse, confirmed, initial encounter

T76.12XA Child physical abuse, suspected, initial encounter

T74.11XA Adult physical abuse, confirmed, initial encounter

T76.11XA Adult physical abuse, suspected, initial encounter

Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
(a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
(b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.

Z86.2       Prsnl history of dis of the bld/bld-form org/immun mechnsm

Z86.39     Personal history of endo, nutritional and metabolic disease

Z87.81     Personal history of (healed) traumatic fracture

Z48.00     Encounter for change or removal of nonsurg wound dressing

Z48.01     Encounter for change or removal of surgical wound dressing

Z48.02     Encounter for removal of sutures

Z48.814   Encntr for surg aftcr fol surg on the teeth or oral cavity

Z48.815   Encntr for surgical aftcr following surgery on the dgstv sy

Z09          Encntr for f/u exam aft trtmt for cond oth than malig neoplm

Category Y93 is provided for use to indicate the activity of the person seeking healthcare for an injury or health condition, such as a heart attack while shoveling snow, which resulted from, or was contributed to, by the activity. These codes are appropriate for use for both acute injuries, such as those from chapter 19, and conditions that are due to the long-term, cumulative effects of an activity, such as those from chapter 13. They are also appropriate for use with external cause codes for cause and intent if identifying the activity provides additional information on the event. These codes should be used in conjunction with codes for external cause status (Y99) and place of occurrence (Y92).

Y93.51     Activity, roller skating (inline) and skateboarding

Y93.5       2Activity, horseback riding

Y93.53     Activity, golf

Y93.55     Activity, bike riding

Y93.56     Activity, jumping rope

Y93.59     Activity, oth w oth sports and athletics played individ

Y93.61     Activity, american tackle football

Y93.62     Activity, american flag or touch football

Y93.63     Activity, rugby

Y93.64     Activity, baseball

Y93.67     Activity, basketball

Y93.68     Activity, volleyball (beach) (court)

Y93.6A     Actvty,physcl games assoc w school recess, sumr camp & child

Y93.69     Actvty, oth w oth sports & athletics played as a team or grp

Y93.72     Activity, wrestling

Y93.73     Activity, racquet and hand sports

Y93.74     Activity, Frisbee

Y93.75     Activity, martial arts

Y93.A1     Activity, exercise machines prim for cardioresp conditioning

Y93.I1      Activity, roller coaster riding

Y93.I9      Activity, other involving external motion

Y93.J4      Activity, winds and brass instrument playing

Y93.K1     Activity, walking an animal

Y93.82     Activity, spectator at an event

Y93.83     Activity, rough housing and horseplay

Y92.099   Unsp place in oth non-institutional residence as place

Y92.79     Oth farm location as place

Y92.838   Oth recreation area as place

Y92.410   Unsp street and highway as place

Y92.29     Oth public building as place

Y92.199   Unsp place in oth residential institution as place

Y92.89     Oth places as the place of occurrence of the external cause

Y92.9       Unspecified place or not applicable

W10.1XXAFall (on)(from) sidewalk curb, initial encounter

W10.8XXAFall (on) (from) other stairs and steps, initial encounter

W11.XXXAFall on and from ladder, initial encounter

W13.9XXAFall from, out of or through bldg, not otherwise spcf, init

W16.92XAJumping or diving into unsp water causing oth injury, init

W17.2XXAFall into hole, initial encounter

W09.8XXAFall on or from other playground equipment, init encntr

W07.XXXAFall from chair, initial encounter

W05.0XXAFall from non-moving wheelchair, initial encounter

W05.1XXAFall from non-moving nonmotorized scooter, initial encounter

W05.2XXAFall from non-moving motorized mobility scooter, init encntr

W06.XXXAFall from bed, initial encounter

W08.XXXAFall from other furniture, initial encounter

W18.11XAFall from or off toilet w/o strike against object, init

W14.XXXAFall from tree, initial encounter

W17.81XAFall down embankment (hill), initial encounter

W17.89XAOther fall from one level to another, initial encounter

V00.141AFall from scooter (nonmotorized), initial encounter

V00.111AFall from in-line roller-skates, initial encounter

V00.151AFall from heelies, initial encounter

V00.131AFall from skateboard, initial encounter

V00.321AFall from snow-skis, initial encounter

V00.312ASnowboarder colliding with stationary object, init encntr

W18.49XAOth slipping, tripping and stumbling w/o falling, init

W03.XXXAOth fall same lev due to collision w another person, init

V00.388AOth accident on flat-bottomed pedestrian conveyance, init

W19.XXXAUnspecified fall, initial encounter

W01.110AFall same lev from slip/trip w strk agnst sharp glass, init

W01.198AFall same lev from slip/trip w strike agnst oth object, init

W18.30XAFall on same level, unspecified, initial encounter

W19.XXXAUnspecified fall, initial encounter

W20.8XXAOth cause of strike by thrown, projected or fall obj, init

W21.89XAStriking against or struck by oth sports equipment, init

W52.XXXACrushd/pushd/stepd on by crowd or human stampede, init

W20.8XXAOth cause of strike by thrown, projected or fall obj, init

W22.03XAWalked into furniture, initial encounter

W22.09XAStriking against other stationary object, initial encounter

W50.0XXAAccidental hit or strike by another person, init encntr

W52.XXXACrushd/pushd/stepd on by crowd or human stampede, init

W18.09XAStriking against oth object w subsequent fall, init encntr

W18.09XAStriking against oth object w subsequent fall, init encntr

W51.XXXAAccidental strike or bumped into by another person, init

W23.0XXACaught, crush, jammed, or pinched betw moving objects, init

V87.0XXSPerson inj in clsn betw car and 2/3-whl pwr veh, sequela

V87.1XXSPerson injured in clsn betw mtr veh and 2/3-whl mv, sequela

V87.2XXSPerson injured in collision betw car and pk-up/van, sequela

V87.3XXSPerson injured in collision betw car and bus, sequela

V87.4XXSPerson injured in collision betw car and hv veh, sequela

V87.5XXSPerson injured in collision betw hv veh and bus, sequela

V87.6XXSPerson injured in clsn betw rail trn/veh and car, sequela

V87.7XXSPerson injured in collision betw oth mtr veh, sequela

V87.8XXSPerson injured in oth nonclsn trnsp acc w mtr veh, sequela

V87.9XXSPerson injured in oth transport acc w non-mv, sequela

V89.2XXSPerson injured in unsp motor-vehicle acc, traffic, sequela

V89.3XXSPerson inj in unsp nonmotor-vehicle acc, traffic, sequela

V89.9XXSPerson injured in unspecified vehicle accident, sequela

V88.9XXSPerson injured in oth trnsp acc w non-mv, nontraf, sequela

V89.1XXSPerson inj in unsp nonmotor-vehicle acc, nontraf, sequela

V97.89XS Oth air transport accidents, NEC, sequela

V98.8XXS Other specified transport accidents, sequela

V99.XXXS Unspecified transport accident, sequela

W17.89XSOther fall from one level to another, sequela

W18.00XSStriking against unsp object with subsequent fall, sequela

W18.30XSFall on same level, unspecified, sequela

W19.XXXSUnspecified fall, sequela

W92.XXXSExposure to excessive heat of man-made origin, sequela

W99.XXXSExposure to other man-made environmental factors, sequela
X39.8XXS Other exposure to forces of nature, sequela

Y33.XXXS Other specified events, undetermined intent, sequela

X58.XXXS Exposure to other specified factors, sequela

CPT Codes

Evaluation & management

(May need modifier if other procedures on the same date of service)

99201      New patient problem focused exam

99202      New patient expanded problem focused exam

99203      New patient detailed problem focused exam

99211      Established patient problem focused exam

99212      Established patient expanded problem focused exam

99213      Established patient detailed problem focused exam

99241      Consultation, problem focused

99242      Consultation, expanded problem focused

99243      Consultation, detailed problem focused

Higher level codes require E&M of multiple body systems

Radiographs

70320      Full mouth series

70300      Radiograph tooth, single view

70310      Radiograph teeth, less than full mouth

70355      Panorex

 

Procedures

Use either the CDT code, if accepted, or 41899 and a narrative for:

Fillings, crowns, root canal therapy, extractions

42100 Biopsy of palate, uvula

Sedation CPT Codes

99143      Moderate conscious sedation, under age 5,30 minutes

99144      Moderate conscious sedation, 5 years and over, 30 minutes

99145      Moderate sedation, each 15 minutes

99148      Moderate sedation provided by another healthcare provider, under age 5, 30 minutes

99149      Moderate sedation, provided by another healthcare provider, 5 years or older, 30 minutes

99150      Moderate sedation, provided by another healthcare provider, each 15 minutes

Modifiers

-25           Significant, Separately identifiable evaluation and management

-26           Professional component

-50           Bilateral procedure

-51           Multiple procedures on same date of service

-52           Reduced services

-99           Multiple modifiers

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