Coding FAQ

Question:

Can you help me with coding for arch bar removal? We did a closed reduction of a right mandibular subcondylar fracture 60 days ago. Now the patient is ready for the arch bars to be removed. It is my understanding that since the arch bars are being removed during the 90 global period that we cannot charge for that procedure. Is that correct?

Answer:

The appropriate code for reporting arch bar removal is CPT 20670 — removal of implant; superficial. It is the position of the AAOMS Committee on Health Care and Advocacy that the removal of arch bars placed in the treatment of a fracture is a separately billable service and not included in the global package of the fracture repair surgery — regardless of who (same surgeon or different surgeon) placed the arch bars in the first place.

Some carriers may require a modifier be appended if the removal is performed within the global period of the initial surgery. Depending on the circumstances, modifier —58 may be an appropriate option.

Question:

I have several doctors who have told me that they learned from AAOMS that they should not file the charges on a biopsy until they receive the pathology report so that the diagnosis is correctly assigned to the charges. This makes no sense to me! I end up with claims for services provided sitting in my insurance queue for weeks while we wait on a report from the outside laboratory. Shouldn't we file the claim with the diagnosis that the doctor assigned when the patient was seen for a consultation?

Answer:

What the doctors have said is correct. When coding anything, whether it is a biopsy or a more extensive surgical procedure in the hospital OR, you always want to report the final diagnosis on the claim. That would be the postoperative diagnosis (as opposed to preoperative diagnosis) listed on the operative report -- or in this case of the biopsy, the final diagnosis coming from the pathology lab. While this may hold up billing at times, it is consistent with coding rules and will keep you out of trouble.

Question:

Where can I obtain a copy of the documentation guidelines used for evaluation and management coding?

Answer:

The E/M Documentation Guidelines found in the AAOMS Coding workbook are a subset of the 1997 guidelines. Here for your information are links to both the 1995 and 1997 complete sets in PDF format off of the CMS web site:

1995 Guidelines
1997 Guidelines

Medicare at the present time allows providers to use either the 1995 or the 1997 guidelines (whichever is more advantageous to the doctor). Whichever set of guidelines a practice decides to use ('95 or '97) — it is most important to carefully follow that set of guidelines to ensure the appropriate level of E/M code is selected every time based on the specific documentation in the record.

Question:

When we bill out for 21196 does the reimbursement we receive from the insurance carrier involve both sides? I mean, we don't bill out 21196, then 21196 again with a 50 modifier? Is it implied with the code that a bilateral procedure is being performed?

Answer:

You are correct. Code 21196 — reconstruction of mandibular rami, and/or body, sagittal split; with internal rigid fixation — is inherently a bilateral code. Therefore, modifier -50 would not be appropriate. In fact, if this procedure is performed unilaterally, it would be appropriate to report it with modifier -52 to reduce the service.

Per CPT Assistant March 1997 Volume 7 Issue 3:

Question:

Does code 21196, Reconstruction of mandibular RAMI and/or body, sagittal split, with internal rigid fixation, refer to a single side or bilateral procedure?

AMA Comment:

Prior to 1996, code 21196 was considered a unilateral procedure, as the descriptor stated ramus. However, in 1996 the descriptor was changed to RAMI, therefore indicating that code 21196 is inherently bilateral. No bilateral modifier is used.

Per CPT Assistant April 1996 Volume 6 Issue 4:

Question:

I noticed in my 1996 CPT book that the mandibular reconstruction codes (21193 - 21196) were changed this year, and now are to be used for a bilateral procedure. What code do I report for a unilateral procedure?

Answer:

CPT codes 21193 and 21195 (as well as 21194 and 21196) were revised in CPT 1996 to more clearly define that these procedures are typically performed on both sides of the mandible, (eg, an osteotomy on the RAMI [plural] as opposed to the ramus [singular]). The procedures reported using these codes (21193 - 21196) are inherently bilateral. For a unilateral procedure, the CPT modifier -52, reduced services, may be reported, in addition to the surgical reconstruction code, to indicate that the service performed was partially reduced at the physician's discretion. Additionally, you may wish to check with your third-party payors for more information concerning the reporting of unilateral procedures.

Question:

Is CPT code 21453 inherently a bilateral or unilateral procedure?

Answer:

The descriptor for code 21453 reads "closed treatment of mandibular fracture with interdental fixation". As it reads fracture (singular) rather than fractures (plural), it would be appropriate to report this code per fracture. However, if two separate fractures of the mandible are treated with arch bar placement, it would be necessary to add the reduced services modifier to the second listing of 21453 to account for the fact that the arch bars are being placed only once, although in treatment of both fractures. For instance, a right angle fracture and a left body fracture, both treated by interdental fixation (arch bars), would appropriately be reported as 21453, 21453 -52. Some carriers may also require the use of the -59 modifier be appended to the second listing of the code to distinguish it from the first.

Question:

I was wondering if you had any insight as to how to bill Medicare for general anesthesia or IV sedation performed by the oral surgeon. We have been running into trouble trying to bill it with -AA or other modifiers.

Answer:

Currently, Medicare does not allow separate reimbursement for general anesthesia when rendered by the operating surgeon, as they consider the reimbursement to be included in the reimbursement of the surgical procedure. Therefore, OMSs may not charge Medicare, nor Medicare beneficiaries for general anesthesia services. Since many third party payers utilize Medicare policy it is possible that other insurance carriers may also bundle payment for general anesthesia.

While AAOMS advocates third party payers provide separate coverage for anesthesia services, OMSs are also encouraged to work directly with their contracted third party payers.

While West Virginia and Ohio Medicare carriers have reported separate payment for operator administered moderate sedation, New Jersey and Michigan Medicare carriers have gone on record that they consider payment for moderate sedation administered by the surgeon to be bundled with the surgical procedure. It is unclear how other Medicare carriers or third party payers will reimburse for moderate conscious sedation when rendered by the operating surgeon as CMS once again "carrier priced" these codes in the 2008 Fee Schedule.

Question:

When is it appropriate to use codes 20900 and 20902 for bone grafts?

Answer:

The heading above codes 20900 and 20902 in the CPT book states "Codes for obtaining autogenous bone, cartilage, tendon, fascia lata grafts, or other tissues through separate skin/fascial incisions should be reported separately unless the code descriptor references the harvesting of the graft or implant (eg, includes obtaining graft)." It would be inappropriate to separately report codes 20900 or 20902 with many of the grafting codes most commonly used by oral and maxillofacial surgeons (such as 21210 and 21215) since they contain the phrase "includes obtaining graft". An example of the use of 20900 or 20902 might be with codes 20955-20962 for a bone graft with microvascular anastomosis. As codes 20955-20962 do not state "includes obtaining graft", it would in these instances be appropriate to separately report the bone harvest.

Question:

Is there a CPT code for brush biopsy?

Answer:

There unfortunately is not a specific code among the OMS codes in CPT to report a brush biopsy. The best way to communicate this to a medical carrier is either through an unlisted CPT code (in conjunction with an operative note) or through the use of the specific CDT/HCPCS code D7288.

Question:

In our office this morning we saw a 1 year old patient that had fallen out of a shopping cart a few days earlier. It was decided that he needed to go to the OR so he could be examined for a possible jaw fracture under anesthesia and at the same time have two teeth extracted. The doctor did a history and physical in the office before going to the OR. Please advise how to code the office part and exam in OR. The doctor did end up extracting the two teeth but there was no evidence of a jaw fracture.

Answer:

As a specific code for exam (of the jaw) under anesthesia does not exist in CPT, the use of an unlisted code such as 21499 may be appropriate. The extractions would be separately billable using the dentoalveolar unlisted code, 41899. Documentation should be submitted along with the claim. As far as the office portion - if the visit meets all of the criteria of a specific level of new or established patient evaluation and management office visit (meaning history, exam and medical decision making) it would be appropriate to bill that level E&M code. If the office visit took place the same day or the day before the patient was taken to the OR, and it was at that visit determined to be necessary to take the patient to the OR, it would be appropriate to append the -57 (decision for surgery) modifier to the E&M service code. Additionally, remember to add to the diagnosis codes the appropriate ICD-9-CM E-code for the fall.

Question:

We had a patient scheduled to come in for biopsy of a mandibular cyst, however when the patient came in for the surgery, the doctor did not find anything. We are having a difference of opinion on whether or not we keep the same code we originally would have used if there had been a cyst, use a different procedure code, or perhaps use a reduced fee modifier with the original code? Thank you for any help you can give us.

Answer:

Since there was no cyst found when the doctor went in to do the procedure, it cannot be coded as a cyst. You can consider using an abnormal radiological findings ICD-9 code like 793.0 (that is if something abnormal was seen on an x-ray) or code V71.89 (observation for suspected condition not found). As far as the procedure code, you can only code as far as the extent of the procedure actually carried out. So an unlisted code would be advisable over the mandibular biopsy code reduced with the -52 modifier. The March/April 2004 AAOMS Today Coding Corner (page 15) addressed a similar issue.

Question:

We are investigating the possibility of billing out for facility charges since we became accredited with AAAHC. Do you know what code we could use? Or do we use the same code as the primary surgical procedure?

Answer:

The format for billing a facility charge can vary depending on whether the submission is to Medicare or Medicaid versus a commercial payer. Which format to use in billing a facility fee should be clarified in the contracting process that occurs between a payer and an ASC.

The standard industry format for Medicare and Medicaid is for services to be reported on a HCFA-1500 form. It is imperative to note that the HCPCS modifier SG (ambulatory surgical center (ASC) facility service) must be appended to every CPT code in order to inform the carrier that the claim is actually billing for a surgical facility as opposed to the professional component of care.

On the commercial insurance side, most carriers do not accept the HCFA-1500 form. The more common method of reporting services to a commercial carrier is with a UB-04 form. This format requires similar demographics and also the precise CPT code and its matched ICD-9-CM code. Additionally, UB-04 formats use revenue codes. The revenue code that must be reported for an ambulatory surgery center is 490. This informs the carrier that the bill represents facility billing.

The AAOMS Committee on Health Care and Advocacy recently developed a coding paper addressing ASC billing.

Question:

Are the CDT codes for impactions based on clinical (intraoperative) observation or presurgical diagnosis from a panorex or other dental x-ray? For example, a tooth looks like the crown is completely covered in bone on panorex, but less than ½ of the crown is covered in bone intraoperatively (partial bony). There also seems to be some confusion regarding whether a full bony impaction requires sectioning of the tooth prior to removal.

Answer:

The AAOMS Committee on Health Care and Advocacy supports that a radiograph alone is not sufficient to determine the level of impaction, and that coding should be based on clinical observation in conjunction with the actual technique used to remove the tooth as documented in the medical record.

In terms of your second question about confusion regarding whether sectioning the tooth is a requirement for an extraction to be considered a full bony impaction — the descriptor for D7240 "requires mucoperiosteal flap elevation and bone removal" and the criteria for a D7241 is "unusually difficult or complicated due to factors such as nerve dissection required, separate closure of maxillary sinus required or aberrant tooth position". So interpreting CDT literally, sectioning is not a requirement.

Question:

We recently purchased an i-CAT machine for our office. How should these scans be reported?

Answer:

Reporting this service to a dental carrier can be reported with one or more codes. CDT code D0360 reads "cone beam ct — craniofacial data capture" and "includes axial, coronal and sagittal data." D0362 is a "cone beam — two-dimensional image reconstruction using existing data, includes multiple images" and D0363 is a "cone beam — three-dimensional image reconstruction using existing data, includes multiple images".

The first of three new codes describe i-CAT scanning with the capture of data via an axial, coronal or sagittal plane. The second and third codes describe any associated reconstruction and differentiate by the type of reconstruction (two dimensional versus three dimensional). It is envisioned that more than one of the above codes could be reported at the same time.

An example of this is a cone beam CT taken in the OMS office where three dimensional reconstruction is necessary to obtain appropriate views. The creation of these codes in CDT 2007/2008 gives OMSs a way to report services previously not well accommodated in CDT.

On the medical side, an i-CAT scan can be reported using CPT code 70486 "computed tomography, maxillofacial area; without contrast material" along with possibly 76376 or 76377 for subsequent manipulations of the data.

Question:

What does RPE stand for and how is it coded?

Answer:

RPE stands for Rapid Palatal Expansion. This procedure is reported with CPT Le Fort I code 21142 and reduced with the -52 modifier to account for the lack of down-fracturing. The May/June 2005 AAOMS Today Coding Corner (page 13) addressed this issue.

Question:

Our surgeon is harvesting bone from a patient's chin and grafting it to her maxillary sinus. The operative report describes this procedure as a "sinus lift". What is the most appropriate way to report this procedure to a medical carrier?

Answer:

A sinus lift is essentially a bone graft to the maxilla. As such, CPT code 21210 (Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)) is an appropriate reporting mechanism. In the scenario above, the surgeon is harvesting bone from the patient's mandible to then place to the maxilla. According to the descriptor of code 21210, obtaining the graft is an essential and therefore included part of the procedure. If however the sinus lift was achieved through the use of synthetic material and without bone harvesting, code 21210 would need to be reduced with the -52 modifier. Another possibility would be a second surgeon harvesting the bone that the first surgeon would then place. In this instance, both surgeons would report 21210 with the -62 (Two Surgeons) modifier. The May/June 2005 AAOMS Today Coding Corner (page 13) addressed this issue.

D7951 is the code that would be used to report this service to a dental carrier.

Question:

How does AAOMS recommend we report a distraction Osteogenesis procedure?

Answer:

A series of codes are necessary to report a distraction osteogenesis accurately. In essence, the procedure involves some type of osteotomy, but not one carried to completion; application of a distraction device; adjustment of the device; and eventual removal of the device. As an example, consider mandibular advancement using distraction osteogenesis.

CPT 21195 — 52 (reconstruction of mandibular rami and/or body, sagittal split, without rigid fixation) would be used to report this initial procedure. Because the osteotomy was not carried out in its entirety, the -52 modifier is appended to indicate a reduced service. Even though the code is inherently bilateral, the appended -52 modifier would still need to be appended even if the procedure were performed unilaterally.

Application of the distraction appliance would be coded with CPT code 20690 (uniplane external fixation appliance) or 20692 (multiplane external fixation system). These codes are for unilateral application. As such, the -50 modifier would be applied is applied bilaterally.

Adjustment of the fixation system would be reported with CPT code 20693 (adjustment of revision of external fixation system requiring anesthesia). If not performed under general anesthesia, adjustent is considered part of the global surgical package for the application procedure (20690 or 20692).

Removal of the fixation system would be coded as CPT 20694 (removal under anesthesia of external fixation system). Again, if the removal is done without general anesthesia, it is considered part of the global surgical package for application of the system.

Question:

Our office recently performed a procedure the surgeon described as Orthodontic Anchorage. Apparently this is the placement of implants for orthodontic anchorage when there is no dentition to support anchorage. How should this be reported to medical and/or dental insurers?

Answer:

CPT code 20650 — Insertion of wire or pin with application of skeletal traction, including removal (separate procedure) — accurately describes the work and practice expense involved with providing this service.

Possible codes for reporting this service to a dental carrier include D7292, D7293 or D7294 depending on the specifics of the case.

Question:

How would you code the marsupialization of a large odontogenic cyst of the maxilla? The oral and maxillofacial surgeon plans to open the cyst and insert a tube in order to allow the cyst to decompress.

Answer:

There is no one distinct code for this situation in CPT, however there are three possible ways to approach reporting it. Marsupialization involves opening of the bone, an incisional biopsy of the lining, and finally, insertion of a tube for decompression. This assumes a rather prolonged course of follow up and frequent office visits (weeks to months) before the definitive surgical excision is performed. Thus, the first method to consider is reporting a biopsy of lesion code with a low RVU and 0 or 10 day global in addition to a low RVU incision and drainage code also with a 0 or 10 day global. Each follow up visit beyond the 0 or 10 day global period should be coded separately with the appropriate established patient E&M code. This method would reflect the longitudinal work in these cases that can extend over several months. If a shorter follow up is anticipated, other options may be considered. The second option would be to use unlisted CPT code 21299, which requires a report, and append staged procedure modifier -58. The staged procedure would indicate that a second procedure was planned from the outset (excision of benign cyst) in the event that it falls within the global surgical period of the first procedure. In the report, reference CPT 42409 (marsupialization of sublingual gland) as the equivalent procedure with an RVU of 6.35 and 90 day global period. The third option would be the use of an excision code with a 90 day global. If this code is selected as your preferred method of billing — you may not charge for any follow-up visits during the 90 day post-operative period.

Question:

Question: We performed extractions on a Medicare patient prior to planned radiation therapy for a malignancy. How should we report this? We are located in Texas and our Medicare carrier is Trailblazer.

Answer:

While this may vary by carrier, ICD-9-CM code V07.8 — other specified prophylactic measure — followed by the ICD-9-CM code representing the patient's head or neck cancer appropriately describes the indications for performing this service.

Question:

Do you know if there is a specific code for a sleep apnea appliance? In this case we are taking the impressions in the office and sending them out to a lab. Once we receive the appliance I bill with E1399, but I am getting denials.

Answer:

There are actually a few different ways you can potentially report this.

If the appliance is being designed and fabricated by the doctor in the office and it is not being sent to an outside lab, consider using code 21089 (unlisted maxillofacial prosthetic procedure). Additionally, a letter of explanation would be required as this is an unlisted code. If on the other hand, an outside laboratory is fabricating the appliance, (which is the scenario per your e-mail), CPT supply code 99070 should be reported and the invoice from the lab should accompany the claim. A letter of explanation indicating what the code is being used for might also be a good idea.

Another option would be to report the HCPCS Durable Medical Equipment "E" codes. E0485 (oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment) or E0486 (oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment) could be appropriate.

The code you mention, E1399 is for miscellaneous durable medical equipment. It might be that one of the above is a bit more specific and preferred by the payer.

Question:

Could you please send me information about the coding of supernumerary teeth. I am receiving denials and am not sure what I am doing wrong.

Answer:

The 2007/2008 CDT Manual includes a section entitled "ADA Dental Claim Form and Completion Instructions". Page 126, #27 addresses the issue of reporting supernumerary teeth. Supernumerary teeth in the permanent dentition should be identified by the numbers 51 through 82, beginning with the area of the upper right third molar, following around the upper arch and continuing on the lower arch to the area of the lower right third molar. An enumeration chart is included in the manual.

Question:

I'm noticing more and more medical insurance plans stating they will not cover general anesthesia on procedures performed in the office because the procedure and the anesthesia are both being administered by the same doctor. Based on what I have read in my coding books this is correct — that anesthesia codes should be used only by physicians not performing the surgical procedures. But then in another coding book it might tell the doctor that only local anesthesia is included in the service so the doctor wants to bill for general anesthesia (CPT 00170) and the actual procedure (example CPT 40819). He also wants to put modifier of -47 which on one plan automatically excludes it from coverage. I'm so confused! Any suggestions on where I can turn to for further clarification of all this?

Answer:

You bring up a lot of good issues here.

What you say about CPT anesthesia chapter codes (00100 — 01999) is correct — CPT's intent is that anesthesia chapter codes are only to be used by a doctor other than the one performing the surgical procedure (that is, anesthesia administered by a second provider). The mechanism CPT created to report anesthesia by surgeon is the -47 modifier. Some payers over the years have however interpreted the anesthesia chapter codes and the -47 modifier differently and/or put into place their own guidelines often contradictory to what is written in CPT.

It is also true that local anesthesia is included in a given surgical procedure code. This holds true in both CPT and CDT. In the CPT book, it is explained in the Surgery Guidelines under the heading of "CPT Surgical Package Definition" preceding the Surgery chapter. In the CDT manual, the statement "Local anesthesia is usually considered to be part of Oral and Maxillofacial Surgical procedures" precedes the Oral and Maxillofacial Surgery chapter.

With the exception of Medicare, when general anesthesia is performed by the operating surgeon, it should be reported separately. Payers differ in how they want anesthesia by surgeon reported. Some payers prefer that general anesthesia performed by the surgeon be reported with anesthesia chapter codes (i.e. 00170), others prefer the use of the -47 modifier (which also happens to be the strict interpretation of CPT) and yet others prefer HCPCS (CDT) codes for anesthesia be reported on the medical claim form.

Moderate sedation, however is handled a bit differently. In the 2008 Physician Fee Schedule, Medicare has once again carrier priced those codes representing moderate conscious sedation by the surgeon. By doing so, CMS continues to give individual Medicare Part B carriers and A/B MACS discretion as to whether to pay the service and at what rate. In a new official Medicare policy published in the August 27, 2007 CMS Transmittal 1324, CMS, for the first time, publicly acknowledges that the operating surgeon may be separately reimbursed for moderate sedation. The new policy states "If the physician performing the procedure also provides moderate sedation for the procedure, then payment may be made for conscious sedation consistent with CPT guidelines." Until now, the Medicare Claims Processing Manual instructed carriers not to allow separate payment for the anesthesia service performed by the physician who also furnishes the medical or surgical services. It stated, for example, that the carriers may not allow separate payment for the surgeon's performance of a local or surgical anesthesia if the surgeon also performs the surgical procedure. This new policy applies only to moderate sedation and not other levels of anesthesia including general, deep, regional or local.

AAOMS encourages you to continue separately billing surgeon administered moderate sedation, using CMS Transmittal 1324 to appeal claim denials from Medicare and perhaps other third party payers as well. This will help supply CMS with needed utilization data in efforts to effect an official policy change.

If in your area you are seeing a growing trend of anesthesia by surgeon being bundled into the surgical procedure, and would like assistance in fighting this, we would be happy to provide you with an appeal packet of arguments to help you contest this practice. You might also look to your state society for further clarification/assistance with these types of issues as they may have more specifics on your local payers and their respective policies.

Question:

My doctor is doing a procedure on a patient with bisphosphonate related osteonecrosis of the jaw (BRONJ). How should I code this diagnosis?

Answer:

There are two different ways at looking at coding for BRONJ. In a case where BRONJ is suspected but no clinical or radiographic signs are evident, you would use the ICD- 9-CM code, V71.89 (observation and evaluation for other specified suspected condition) accompanied by the appropriate Evaluation and Management (E& M) code for the clinical evaluation.

In the cases where a diagnosis of BRONJ is confirmed, there is a new ICD-9- CM code for aseptic osteonecrosis of the jaw, 733.45. There are also two new ICD-9-CM E codes, E933.6 and E933.7 to track the route of administration. E933.7 describes the use of bisphosphonates administered intravenously and E933.6 describes the oral administration of the drug. In addition to these codes, an E code can be used to list the appropriate drug or drugs given in combination with the bisphosphonates, such as antineoplastic and immunosuppressive drugs (E933.1). Use of the appropriate ICD-9-CM code for the disease state (e.g., particular cancers, osteoporosis or Paget's disease) may also be required.

Question:

How do you report tooth numbering on the CMS 1500 form?

Answer:

Field 24 on the CMS 1500 form has been updated to accommodate the reporting of tooth numbers and area of the oral cavity. The revised instructions are available on the National Uniform Claim Committee (NUCC) website. There is now a shaded area in fields 24A-24G where you may report tooth numbers and other supplemental information such as anesthesia time and narrative descriptions of unspecified codes. A qualifier should be used when reporting any of these services.

To report a tooth number, report data in the following order: qualifier, tooth number, e.g., JP16. When reporting an area of the oral cavity, enter in the following order: qualifier, the area of oral cavity code, e.g., JO10.

When reporting multiple tooth numbers for one procedure, report in the following order: qualifier, tooth number, blank space, tooth number, blank space, tooth number, etc., e.g., JP1 16 17 32.
When reporting multiple tooth numbers for one procedure, the number of units reported in 24G is the number of teeth involved in the procedure.
When reporting multiple areas of the oral cavity for one procedure, add in the following order: qualifier, oral cavity code, blank space, oral cavity code, etc., e.g., JO10 20.
When reporting multiple areas of the oral cavity for one procedure, the number of units reported in 24G is the number of areas of the oral cavity involved in the procedure.

The following qualifiers may be used:

7	Anesthesia information
ZZ	Narrative description of unspecified code
N4	National Drug Codes (NDC)
VP	Vendor Product Number Health Industry Business Communications Council (HIBCC) Labeling Standard
OZ	Product Number Health Care Uniform Code Council — Global Trade Item Number (GTIN)
CTR	Contract rate
JP	Universal/National Tooth Designation System
JO	ANSI/ADA/ISO Specification No. 3950-1984 Dentistry Designation System for Tooth and Areas of the Oral Cavity

The following are the codes for tooth numbers, reported with the JP qualifier:

1—32	Permanent dentition
51—82	Permanent supernumerary dentition
A—T	Primary dentition
AS—TS	Primary supernumerary dentition

The following are the codes for areas of the oral cavity, reported with the JO qualifier:

00	Entire oral cavity
01	Maxillary arch
02	Mandibular arch
10	Upper right quadrant
20	Upper left quadrant
30	Lower left quadrant
40	Lower right quadrant

For further information on these codes, refer to the Current Dental Terminology (CDT) Manual available from the American Dental Association.

Question:

How do you code the use of platelet rich plasma (PRP) in bone augmentation procedures?

Answer:

As of July 1, 2010 a new Category III CPT code is available for reporting the use of platelet rich plasma. A category III code is a temporary code describing an emerging technology, service and/or procedure that may or may not eventually be converted to a Category I CPT code. The descriptor for code 0232T reads "injection(s), platelet rich plasma, any tissue, including image guidance, harvesting and preparation when performed)". While the code will be published in the Category III code section of the 2011 CPT manual effective January 1, 2011, the new PRP code (0232T) can be used starting with dates of service July 1, 2010. Pages 4-5 of MLN Matters article MM6996 and an AMA CPT Category III Codes document provide additional information on the implementation schedule for Category III CPT codes.

Before July 1st code P9020 (platelet rich plasma, each unit) found in the HCPCS Book under the title "Pathology and Laboratory" and in the subtitle "Miscellaneous Pathology and Laboratory" was commonly reported. There are special coverage instructions associated with this code, which means local Medicare carriers may have specific coverage instructions for processing this code. The use of this or any other code does not guarantee payment. OMSs are encouraged to review their Medicare provider manual or carrier's website, or consult with the third party payer for coverage information.

Question:

I have heard ICD-10-CM is coming. How should I begin to prepare?

Answer:

Start by participating in the September 15, 2010 AAOMS webinar being presented by distinguished AAOMS coding and billing workshop speaker, Dawn W. Jackson, DrPH, RHIA, CCS-P, FAHIMA. The new diagnostic coding system officially replaces ICD-9-CM effective October 1, 2013. AAOMS� first webinar devoted purely to ICD-10-CM, Making the Transition to ICD-10-CM, will help providers learn more about the preparations they must make in anticipation of its implementation. Learn more by visiting the Practice Management Workshops & Webinars page. OMSs are encouraged to participate along with coding and billing staff as ICD-10-CM will be a major change affecting not only coding, but will impact documentation as well.

In the meantime, providers may visit the ICD-10-CM section of the National Center for Health Statistics (NCHS) web site to preview the 2010 update of ICD-10-CM. Multiple resources are also available on the American Health Information Management Association (AHIMA) web site to assist providers with preparing for ICD-10. For more information you may also consider visiting the ICD-10 section of the CMS web site. Be sure to also continue monitoring the AAOMS Today and Practice Management pages of the AAOMS website for updates.

Question:

How should a sinus tap be reported to a dental carrier?

Answer:

The closest code currently available is D7953 (bone replacement graft for ridge preservation - per site).