Medical Insurance Coding

Submitting dental procedures to medical insurance requires the use of Current Procedural Terminology (CPT) codes. These are the standard codes used to describe dental procedures and services.

1. Examinations and Evaluations:

• Comprehensive Oral Evaluation: CPT 99205 (new patient office visit) requires these 3 key components:

  • A comprehensive history- Chief complaint, extended history of present illness, review of all systems, and complete past, family, and social history.

  • A comprehensive examination

  • Medical decision making of high complexity- Extensive diagnosis or treatment options, extensive data to review, and high risk of complications.

• Office Visit: CPT 99211-99215 (established patient office visit). These are apart of ongoing management and evaluation of patients.

• Limited Oral Evaluation: CPT 99201-99215 (depending on the extent and type of visit)

2. Radiographs (X-rays):

• Panoramic X-ray: CPT 70355

• CBCT X-ray: CPT 70486

• Intraoral - Complete Series: CPT 70350

3. Surgical Procedures:

• Extractions (simple or surgical): CPT 41899 (unlisted procedure, dentoalveolar structures)

• Removal of Impacted Tooth: CPT 41899

4. Anesthesia:

• Local Anesthesia: Usually included in the procedure code

• IV Sedation (per 15 minutes): CPT 99151-99157 (depends on age and time)

5. Reconstructive Procedures:

• Bone Grafting: CPT 21249 (graft, bone; nasal, maxillary or malar areas (includes obtaining graft))

• Dental Implant: CPT 21248 (immediate placement of endosseous dental implant at time of extraction)

6. Other Common Procedures:

• Biopsy of Oral Tissue: CPT 40808

• Alveoloplasty (surgical preparation of the jaw): CPT 41870

Some dental procedures might not have direct CPT equivalents and might require the use of unlisted codes like CPT 41899, which can then be detailed in the claim submission.

Unspecified/Unlisted CPT Codes

For dental procedures that don't have specific CPT codes, you can use the following unlisted procedure codes:

1. CPT 41899 - Unlisted procedure, dentoalveolar structures

• This is a catch-all code used for any dental procedures involving the alveolar structures that are not specifically listed in the previous CPT code set.

  When using this code, you must provide a detailed description of the procedure performed.

2. CPT 21299 - Unlisted craniofacial and maxillofacial procedure

• This code is used for unlisted procedures involving the craniofacial and maxillofacial areas. It is useful for complex procedures that do not fit into other specific categories.

3. CPT 21089 - Unlisted maxillofacial prosthetic procedure

• This code is used for maxillofacial prosthetic procedures that are not specifically described by other codes.

Important Considerations:

• Documentation: Proper documentation is crucial to justify the use of these codes, including detailed notes on the congenital defect or trauma, surgical approach, and any grafts used.

• Payer Guidelines: Check with insurance payers for specific coverage policies and requirements related to this procedure code.