Help: FAQs, tutorials, videos, page index and more
Viewing:  Jan 20, 2019

The Diabetic Patient and Medical Manifestations

By:  Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Published:  December 20th, 2018

Treating a diabetic patient with medical oral complications may be covered under the patient's medical plan. With the patient's oral health at risk, the medical portion may reimburse for certain procedures, since medical plans only pay from medical necessity the treatment must be considered medically necessary. A diabetic patient is considered high risk and if the diabetes is marginally or poorly controlled may pose greater oral complications requiring medical intervention.

Some Oral manifestations that are generally seen may include some of the following:

  • Gingivitis
  • Periodontitis
  • Disturbances of salivary secretion (Hypoptyalism, Ptyalism, Xerostomia)
  • Burning sensation in the mouth (possibly be related to neuropathy)
  • Impaired/delayed wound healing, increased incidence, and severity of infections
  • Secondary infection with candidiasis
  • Parotid salivary gland enlargement

With the above medical problems, you may consider billing the patients medical plan.

NOTE: Always check with the payer for coverage and exclusions for the patient's medical plan.

For example, if you were to bill the dental plan you would use the Dental Code, D4210 Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant.

When billing the medical plan you would use the following medical codes:

41872 Gingivoplasty each quadrant specify

K05.10 - Chronic gingivitis, plaque-induced

E11.630 - Type 2 diabetes mellitus with periodontal disease

 


References:

###

Article Tags:  (Click on a tag to see related articles.)



Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.

Our contact information:

Find A Code, LLC
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Fax: 801-770-4428
Email:
Free 28 Day Trial
No Credit Card Required
Pricing
Starting at $10/month
Sign In
Welcome back!