Common Medical to Dental Procedures and Where to Find Them

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
December 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. 

00100 01999     Anesthesia

10004

69990  

 

Surgery

70010 79999     Radiology Procedures
0001U 89398     Pathology and Laboratory Procedures
90281 99607     Medicine Services and Procedures
99091 99499     Evaluation and Management Services

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

10004 10021     General Surgical Procedures
10030 19499     Surgical Procedures on the Integumentary System

20100

29999  

 

Surgical Procedures on the Musculoskeletal System

30000 32999     Surgical Procedures on the Respiratory System
33016 37799     Surgical Procedures on the Cardiovascular System
38100 38999     Surgical Procedures on the Hemic and Lymphatic Systems
39000 39599     Surgical Procedures on the Mediastinum and Diaphragm
40490 49999     Surgical Procedures on the Digestive System
50010 53899     Surgical Procedures on the Urinary System
54000 55899     Surgical Procedures on the Male Genital System
55920 55920     Reproductive System Procedures
55970 55980     Intersex Surgery
56405 58999     Surgical Procedures on the Female Genital System
59000 59899     Surgical Procedures for Maternity Care and Delivery
60000 60699     Surgical Procedures on the Endocrine System
61000 64999     Surgical Procedures on the Nervous System
65091 68899     Surgical Procedures on the Eye and Ocular Adnexa
69000 69979     Surgical Procedures on the Auditory System
69990 69990     Operating Microscope Procedures

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

Surgery
  Surgical Procedures on the Musculoskeletal System

20100 20999     General Surgical Procedures on the Musculoskeletal System

21010

21499  

 

Surgical Procedures on the Head

21501 21899     Surgical Procedures on the Neck (Soft Tissues) and Thorax
21920 21936     Surgical Procedures on the Back and Flank
22010 22899     Surgical Procedures on the Spine (Vertebral Column) Cervical, thoracic, and lumbar spine.
22900 22999     Surgical Procedures on the Abdomen
23000 23929     Surgical Procedures on the Shoulder
23930 24999     Surgical Procedures on the Humerus (Upper Arm) and Elbow
25000 25999     Surgical Procedures on the Forearm and Wrist
26010 26989     Surgical Procedures on the Hand and Fingers
26990 27299     Surgical Procedures on the Pelvis and Hip Joint
27301 27599     Surgical Procedures on the Femur (Thigh Region) and Knee Joint
27600 27899     Surgical Procedures on the Leg (Tibia and Fibula) and Ankle Joint
28001 28899     Surgical Procedures on the Foot and Toes
29000 29799     Application of Casts and Strapping
29800 29999     Endoscopy/Arthroscopy 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).

Surgery
  Surgical Procedures on the Musculoskeletal System
    Surgical Procedures on the Head

21010 21010     Incision Procedures on the Head
21011 21070     Excision Procedures on the Head
21073 21073     Manipulation Procedures of Head
21076 21089     Head Prosthesis Preparation
21100 21116     Introduction Procedures on the Head
21120 21296     Repair, Revision, and/or Reconstruction Procedures on the Head
21299 21299     Other Craniofacial and Maxillofacial Procedures of the Head

21310

21497  

 

Fracture and/or Dislocation Procedures on the Head

21499 21499     Other Musculoskeletal Procedures of the Head

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

21461 21462     Open treatment of mandibular fracture
21465   OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE
21470   OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION
21480 21485     Closed treatment of temporomandibular dislocation

21490

 

OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION

21497   INTERDENTAL WIRING OTHER THAN FRACTURE

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.

Common Medical to Dental Procedures and Where to Find Them. (2020, December 8). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/common-medical-to-dental-procedures-36701.html

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