Oral Surgery Medical In Nature - Aetna Dental · Medical in Nature Oral Surgery Effective...
Transcript of Oral Surgery Medical In Nature - Aetna Dental · Medical in Nature Oral Surgery Effective...
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2018
Medical in Nature Oral Surgery Effective 01/01/2018
CDT Code Description (CDT code)
CPT Code Description (CPT Code)
Requires Precert / Review by OMFS PM
D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth
21140 Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)
D7285 Biopsy of oral tissue (hard)
20220 20240 20245
Biopsy, muscle; superficial
Biopsy, bone, excisional;
superficial Biopsy, bone, excisional;
deep
D7286 Biopsy of oral tissue (soft)
20200 20205 40490 40808 41100 41105 41108 42100 42800
Biopsy, muscle; superficial
Biopsy, muscle; deep Biopsy of lip Biopsy, vestibule of
mouth Biopsy of tongue,
anterior two-thirds Biopsy of tongue,
Posterior one-third Biopsy floor of mouth Biopsy of palate, uvula Biopsy of oropharynx
D7287 Cytology sample collection
88104 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation
X
D7288
Brush biopsy - transepithelial sample collection
88112 Cytopathology, selective cellular enhancement technique with interpretation (e.g. Liquid based slide preparation method), except cervical or vaginal
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2018
D7295 Harvest of bone for use in autogenous grafting procedures
21215, 21210 - includes obtaining the graft, in which case this code would not be covered 20900 - bone graft any donor area
D7296 Corticotomy - one to three teeth or tooth spaces, per quadrant
21198-52 Osteotomy, mandible, segmental;
X
D7297 Corticotomy – four or more teeth or tooth spaces, per quadrant
21206-52 Osteotomy, maxilla, segmental (eg, Wassmund or Schuchard)
X
D7410 Excision of benign lesion up to 1.25 cm
21015 Radical resection of tumor (e.g., malignant neoplasm); soft tissue of face or scalp
D7411 Excision of benign lesion greater than 1.25 cm
21030 21040
Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage
Excision of benign tumor
or cyst of mandible, by enucleation and curettage
D7412 Excision of benign lesion, complicated
41827 Excision of lesion or tumor, dentoalveolar structures, with complex repair
D7413 Excision of malignant lesion up to 1.25 cm
21034 21044
Excision of malignant tumor of maxilla or zygoma
Excision of malignant tumor of mandible
D7414 Excision of malignant lesion greater than 1.25 cm
21034 21044
Excision of malignant tumor of maxilla or zygoma
Excision of malignant tumor of mandible
D7415 Excision of malignant lesion, complicated
21034 21044 21045
Excision of malignant tumor of maxilla or zygoma
Excision of malignant tumor of mandible
Excision of malignant tumor of mandible; radical resection
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2018
D7440 Excision of malignant tumor – lesion diameter up to 1.25 cm
21034 Excision of malignant tumor of maxilla or zygoma
Excision of malignant
tumor of mandible; Excision of malignant
tumor of mandible; radical resection
21044 21045
D7441 Excision of malignant tumor – lesion diameter over 1.25 cm
21034 Excision of malignant tumor of maxilla or zygoma
21044 21045
Excision of malignant tumor of mandible;
Excision of malignant
tumor of mandible; radical resection
D7450 Removal of benign odontogenic cyst or tumor; lesion diameter up to 1.25 cm
21030 21040 41825 41826 41827
Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage
Excision of benign cyst
or tumor of mandible, by enucleation and/or curettage
Excision of lesion or
tumor, dentoalveolar structures; without repair
Excision of lesion or
tumor, dentoalveolar structures; with simple repair
Excision of lesion or
tumor, dentoalveolar structures; with complex repair
Review when submitted in conjunction with removal of impacted teeth
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2018
D7451 Removal of benign
odontogenic cyst or tumor; lesion diameter greater than 1.25 cm
21030 21040 41825 41826 41827
Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage
Excision of benign cyst
or tumor of mandible, by enucleation and/or curettage
Excision of lesion or
tumor, dentoalveolar structures; without repair
Excision of lesion or
tumor, dentoalveolar structures; with simple repair
Excision of lesion or
tumor, dentoalveolar structures; with complex repair
Review when submitted in conjunction with removal of impacted teeth
D7460 Removal of benign non-odontogenic cyst or tumor; lesion diameter up to 1.25 cm
21030 21040 41825 41826 41827
Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage
Excision of benign cyst
or tumor of mandible, by enucleation and/or curettage
Excision of lesion or
tumor, dentoalveolar structures; without repair
Excision of lesion or
tumor, dentoalveolar structures; with simple repair
Excision of lesion or
tumor, dentoalveolar structures; with complex repair
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2018
D7461 Removal of benign non-odontogenic cyst or tumor; lesion diameter greater than 1.25 cm
21030 21040 41825 41826 41827
Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage
Excision of benign cyst or tumor of mandible, by enucleation and/or curettage
Excision of lesion or tumor, dentoalveolar structures; without repair
Excision of lesion or tumor, dentoalveolar structures; with simple repair
Excision of lesion or tumor, dentoalveolar structures; with complex repair
D7465 Destruction of lesion(s) by physical or chemical methods – by report
40820 41850 42160
Destruction of lesion or scar of vestibule of mouth by physical methods
Destruction of lesion;
dentoalveolar structures
Destruction of lesion,
palate or uvula
D7480 (code deleted 2003)
Partial ostectomy (guttering or saucerization)
21025 Excision of bone, mandible (e.g., for osteomyelitis or bone abscess)
X
21026 Excision of bone, facial bones
D7490 Radical resection of mandible with bone graft
21045 Excision of malignant tumor of mandible, radical resection
X
21215 Graft, bone; mandible X
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2018
D7510 Incision and
drainage of abscess – intraoral soft tissue
20000 40800 41000 41005 41007 41008 41009 41800 42000 42310
Incision of soft tissue abscess (e.g., secondary to osteomyelitis); superficial
Drainage of abscess, cyst hematoma, vestibule of mouth; simple
Intraoral incision and drainage of abscess, cyst or hematoma of tongue or floor of mouth; lingual
Intraoral incision and drainage of abscess, cyst or hematoma of tongue or floor of mouth; sublingual, superficial
Intraoral incision and drainage of abscess, cyst or hematoma of tongue or floor of mouth; submental space
Intraoral incision and drainage of abscess, cyst or hematoma of tongue or floor of mouth; submandibular space
Intraoral incision and drainage of abscess, cyst or hematoma of tongue or floor of mouth; masticator space
Drainage of abscess, cyst, hematoma from dentoalveolar structures
Drainage of abscess of palate, uvula
Drainage of abscess; submaxillary or sublingual, intraoral
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7511
Incision and drainage of abscess – intraoral soft tissue – complicated (includes drainage of multiple fascial spaces)
20005 40801 41006
Incision of soft tissue abscess (secondary to osteomyelitis); deep or complicated
Drainage of abscess,
cyst hematoma, vestibule of mouth; complicated
Intraoral incision and
drainage of abscess, cyst or hematoma of tongue or floor of mouth: sublingual, deep, supramylohyoid
D7520 Incision and drainage of abscess – extraoral soft tissue
10180 41015 41016 41017 41018 42300
Incision and drainage, complex, postoperative wound infection
Extraoral incision and
drainage of abscess, cyst or hematoma of floor of mouth; sublingual
Extraoral incision and
drainage of abscess, cyst or hematoma of floor of mouth; submental
Extraoral incision and
drainage of abscess, cyst or hematoma of floor of mouth; submandibular
Extraoral incision and
drainage of abscess, cyst or hematoma of floor of mouth; masticator space
Drainage of abscess;
parotis, simple
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7521
Incision and drainage of abscess – extraoral soft tissue – complicated (includes drainage of multiple fascial spaces)
42320 42305
Drainage of abscess; submaxillary external
Drainage of abscess;
parotid, parotid, complicated
D7530 Removal of foreign body from mucosa, skin, or subcutaneous alveolar tissue
20670 40804 41805
Removal of implant; superficial (e.g., buried wire, pin, or rod)
Removal of embedded
foreign body, vestibule of mouth; simple
Removal of embedded
foreign body from dentoalveolar structures, soft tissue
D7540 Removal of reaction producing foreign bodies, musculoskeletal
20680 40805 41806
Removal of implant; deep (e.g., buried wire, pin, or rod)
Removal of embedded
foreign body, vestibule of mouth; simple
Removal of embedded
foreign body from dentoalveolar structures; bone
D7550 Partial ostectomy/ sequestrectomy for removal of non-vital bone
21025 Excision of bone, mandible (e.g., for osteomyelitis or bone abscess)
X
41830 Alveolectomy, including curettage of osteitis or sequestrectomy
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7560 Maxillary sinusotomy for removal of tooth fragment or foreign body
31020 31030
Sinusotomy, maxillary (antrotomy); intranasal
Radical (Caldwell-Luc)
without removal of antrochoanal polyps
D7610 Maxilla, simple fracture, open reduction, teeth immobilized (if present)
21445 Open treatment of mandibular or maxillary alveolar ridge fracture
D7620 Maxilla, simple fracture, closed reduction, teeth immobilized (if present
21440 Closed treatment of mandibular or maxillary alveolar ridge fracture
D7630 Mandible, simple fracture, open reduction, teeth immobilized (if present)
21462 Open treatment of mandibular fracture: with interdental fixation
D7640 Mandible, simple fracture, closed reduction, teeth immobilized (if present)
21450 21451 21453
Closed treatment of mandibular fracture; without manipulation
Closed treatment of
mandibular fracture; with manipulation
Closed treatment of
mandibular fracture; with interdental fixation
D7650 Malar and/or zygomatic arch, simple fracture, open reduction
21356 21360
Open treatment of depressed zygomatic fracture (e.g., Gillies approach)
Open treatment of
depressed malar fracture, including zygomatic arch and malar tripod
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7660 Malar and/or zygomatic arch, simple fracture, closed reduction
21355 Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation
D7670 Fracture – simple - Alveolus – closed reduction, may include stabilization of teeth
21440 Closed treatment of mandibular or maxillary alveolar ridge fracture
D7671 Fracture – simple - Alveolus – open reduction, may include stabilization of teeth
21445 Open treatment of mandibular or maxillary alveolar ridge fracture
D7680 Facial bones, simple fracture, complicated reduction with fixation and multiple surgical approaches
21432 21433 21435
Open treatment of craniofacial separation (LeForte III type); with wiring and/or internal fixation
Open treatment of
craniofacial separation (LeForte III type) complicated (e.g., comminuted or involving cranial nerve foramina), multiple surgical approaches
Open treatment of
craniofacial separation (LeForte III type) complicated, utilizing internal and/or external fixation techniques (e.g., head cap, halo device, and/or intermaxillary fixation)
D7710 Maxilla, compound fracture, open reduction
21422 21423
Open treatment of palatal or maxillary fracture (Leforte 1 type) Open treatment of palatal or maxillary fracture (Leforte 1 type) complicated (comminuted), multiple approaches
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7720 Maxilla, compound fracture, closed reduction
21421 Closed treatment of palatal or maxillary fracture (Leforte 1 type), with interdental wire fixation or fixation of denture or splint
D7730 Mandible, compound fracture, open reduction
21461 21462 21465
Open treatment of mandibular fracture; without interdental fixation
Open treatment of
mandibular fracture; with interdental fixation
Open treatment of
mandibular condylar fracture
D7740 Mandible, compound fracture, closed reduction
21453 Closed treatment of mandibular fracture with interdental fixation
D7750 Malar and/or zygomatic arch, compound fracture, open reduction
21360 21365 21366
Open treatment of depressed malar fracture, including zygomatic arch and malar tripod
Open treatment of
complicated fracture(s) of malar area, etc.
Open treatment of
complicated fracture(s) of malar area, etc. with bone grafting (includes obtaining graft)
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7760 Malar and/or
zygomatic arch, compound fracture, closed reduction
21355 Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation
D7770 Fracture – compound - Alveolus - open reduction stabilization of teeth
21445 Open treatment of mandibular or maxillary alveolar ridge fracture
D7771 Fracture – compound - Alveolus – closed reduction stabilization of teeth
21440 Closed treatment of mandibular or maxillary alveolar ridge fracture
D7780 Facial bones, compound fracture, complicated reduction with fixation and multiple surgical approaches
21346 21347 21348
Open treatment of nasomaxillary complex fracture (Leforte II); with wiring and/or local fixation
Open treatment of
nasomaxillary complex fracture (Leforte II); requiring multiple open approaches
Open treatment of
nasomaxillary complex fracture (Leforte II); with bone grafting
D7810 Open reduction of dislocation
21490 Open treatment of temporomandibular dislocation
X
D7820 Closed reduction of dislocation
21480 Closed treatment of temporomandibular dislocation; initial or subsequent
X
D7830 Manipulation under anesthesia
21485 Closed treatment of TMJ dislocation – complicated
X
D7840 Condylectomy (non-ortho related)
21050 Condylectomy, temporomandibular joint
X
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7850 Meniscectomy (non-ortho related)
21060 Meniscectomy, partial or complete, temporomandibular joint
X
D7852 Disc repair 21240 Arthroplasty, temporomandibular joint, with or without autograft
X
D7854 Synovectomy 21240 Arthroplasty, temporomandibular joint, with or without autograft
X
D7856 Myotomy 21240 Arthroplasty, temporomandibular joint, with or without autograft
X
D7858 Joint reconstruction 21242 21243 21247
Arthroplasty, temporomandibular joint, with allograft
Arthroplasty,
temporomandibular joint, with prosthetic joint replacement
Reconstruction of
mandibular condyle with bone and cartilage autografts
X
X
X
D7860 Arthrotomy 21010 Arthrotomy, temporomandibular joint
X
D7865 Arthroplasty 21240 Arthroplasty, temporomandibular joint, with or without autograft
X
D7870 Arthrocentesis 20605 Arthrocentesis--- intermediate joint, bursa or ganglion (e.g., temporomandibular joint, etc.)
X Effective 12/03/2013, pre-
cert no longer required
D7871 Non-arthroscopic lysis and lavage
20605 Arthrocentesis--- intermediate joint, bursa or ganglion (e.g., temporomandibular joint, etc.)
X
D7872 Arthroscopy – diagnosis, with or without biopsy
29800 Arthroscopy, temporomandibular joint, diagnostic
X
D7873 Arthroscopy – surgical: lysis and lavage of adhesions
29804 Arthroscopy, temporomandibular joint, surgical
X
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7874 Arthroscopy –
surgical: disc repositioning and stabilization
29804 Arthroscopy, temporomandibular joint, surgical
X
D7875 Arthroscopy – surgical: synovectomy
29804 Arthroscopy, temporomandibular joint, surgical
X
D7876 Arthroscopy – surgical: discectomy
29804 Arthroscopy, temporomandibular joint, surgical
X
D7877 Arthroscopy – surgical: debridement
29804 Arthroscopy, temporomandibular joint, surgical
X
D7910 Suture of recent small wounds up to 5 cm
12011 12013 40830 41250 41251 42180
Simple repair of superficial wounds of face, ears, eyelids, nose, lips, and/or mucous membranes 2.5 cm or less
Simple repair of
superficial wounds of face, ears, eyelids, nose, lips, and/or mucous membranes 2.7 – 5.0 cm
Closure of laceration,
vestibule of mouth, 2.5 cm or less
Repair of laceration
2.5.cm or less; floor of mouth and/or anterior 2/3 of tongue
Repair of laceration
2.5.cm or less; floor of mouth and/or posterior 1/3
of tongue Repair, laceration of
palate, up to 2 cm
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7911 Complicated sutures - up to 5 cm.
12051 12052 40831 42182
Layer closure of wounds of face, etc; 2.5 cm or less
Layer closure of wounds
of face, ears, etc. – 2.6 cm to 5.0 cm
Closure of laceration,
vestibule of mouth, over 2.5 cm or complex
Repair, laceration of
palate, over 2 cm or complex
D7912 Complicated sutures
12053 12054 12055 41252
Layer closure of wounds of face, ears, etc. –5.1 cm to 7.5 cm
Layer closure of wounds
of face, ears, etc. - 7.6 cm to 12.5 cm
Layer closure of wounds
of face, ears, etc. - 12.6 cm to 20.0 cm Repair of laceration of tongue, floor of mouth, over 2.6 cm or complex
D7920 Skin graft (identify defect covered, location and type of graft)
15350 Application of allograft, skin, 100 sq. cm or less
X
D7940 Osteoplasty for orthognathic deformities (non- ortho related)
21208 21209
Osteoplasty, facial bones, augmentation (autograft, allograft or prosthetic implant)
Osteoplasty, facial
bones, reduction
X
X
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7941 Osteotomy –
mandibular rami 21193 21195 21196 21199
Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy w/o bone graft
Reconstruction of
mandibular rami and/or body, sagittal split; without internal rigid fixation
Reconstruction of
mandibular rami and/or body, sagittal split; with internal rigid fixation
Osteotomy, mandible,
segmental; with genioglossus advancement
X
X
X
X
D7943 Osteotomy – ramus, open with bone graft
21194 Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy With bone graft (includes obtaining graft)
X
D7944 Osteotomy – segmented or subapical, per sextant or quadrant
21198 21199 21206
Osteotomy, mandible, segmental
Osteotomy, mandible,
segmental with genioglossus advancement
Osteotomy, maxilla,
segmental (e.g., Wassmund or Schuchard)
X
X
X
D7945 Osteotomy – body of mandible
21198 Osteotomy, mandible, segmental
X
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7946 Leforte I (maxilla – total)
21141 21145
Reconstruction midface, Leforte I; single piece, segment moving in any direction w/out bone graft
Reconstruction midface,
Leforte I; single piece, segment moving in any direction requiring bone grafts
X
X
D7947 Lefort I (maxilla - segmented)
21142 21143 21146 21147
Reconstruction of midface, etc.—two pieces, segment moving in any direction, without bone graft
Reconstruction of
midface, etc three or more pieces, segment moving in any direction, without bone graft
Reconstruction of
midface, etc two pieces, segment moving in any direction, requiring bone grafts (includes obtaining grafts)
Reconstruction of
midface, etc three or more pieces, segment moving in any direction, requiring bone grafts includes obtaining grafts)
X
X
X
X
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7948 Lefort II or III - without bone graft
21150 Reconstruction midface, Leforte II; anterior intrusion
D7949 Lefort II or III - with bone graft
21151 21154 21159
Reconstruction midface, Leforte II— any direction requiring bone grafts (includes obtaining grafts)
Reconstruction midface,
Leforte III— any type, requiring bone grafts (includes obtaining grafts)
Reconstruction midface,
Leforte III--- with forehead advancement requiring bone grafts (includes obtaining grafts); without Leforte I
D7950 Osseous, osteoperiosteal, or cartilage graft of the mandible or facial bones – autogenous or nonautogenous, by report
21210 21215
Graft, bone, nasal, maxillary or malar areas (includes obtaining graft)
Graft, bone, mandible
(includes obtaining graft
X
X
D7951 Sinus agumentation with bone or bone substitutes via a lateral open approach
21210 Graft, bone, nasal, maxillary or molar areas (includes obtaining graft)
X
D7952 Sinus 21216 21210
Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard) Graft, bone, nasal, maxillary or molar areas (includes obtaining graft)
X
X
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7955 Repair of maxillofacial soft & hard tissue defects
21208 21270
Osteoplasty, facial bones, augmentation (autograft, allograft or prosthetic implant)
Malar augmentation,
prosthetic material
X
X
D7980 Sialolithotomy 42330 42335 42340
Sialolithotomy, submandibular, sublingual, or parotid, uncomplicated intraoral
Sialolithotomy,
submandibular, complicated; intraoral
Sialolithotomy, parotid,
extraoral or complicated intraoral
D7981 Excision of salivary gland
42410 42415 42420 42425 42440
Excision of parotid tumor or parotid gland; lateral lobe, w/o nerve dissection
Excision of parotid tumor
or parotid gland; lateral lobe, with dissection and preservation of facial nerve
Excision of parotid tumor
or parotid gland; total, with dissection and preservation of facial nerve
Excision of parotid tumor
or parotid gland; total, en block removal with sacrifice of facial nerve
Excision of
submandibular gland
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
42450
42507 42508 42509
Excision of sublingual gland
Parotid duct diversion,
bilateral (Wilke type procedure);
Parotid duct diversion,
bilateral with excision of one submandibular gland
Parotid duct diversion, bilateral with excision of both submandibular glands
D7982 Sialodochoplasty 42500 42505
Plastic repair of salivary duct, sialodochoplasty. Primary or simple Plastic repair of salivary duct, sialodochoplasty. secondary or complicated
D7983 Closure of salivary fistula
42600 Closure of salivary fistula
D7990 Emergency tracheotomy
31603 31605
Tracheostomy, emergency procedure; transtracheal Tracheostomy, emergency procedure; cricothyroid membrane
D7991 Coronoidectomy 21070 Coronoidectomy X
D7995 Synthetic graft – mandible or facial bones, by report
21125 Augmentation, mandibular body or angle; prosthetic material
X
D7996 Implant-mandible for augmentation purposes
21120 21127
Genioplasty, augmentation (autograft, allograft or prosthetic material) Augmentation, mandibular body or angle, with bone graft, onlay or interpositional
X
X
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Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2015
D7997 Appliance removal (not by the dentist who placed appl.)
20670 21046 21047 21048 21049
Removal of implant, superficial (e.g., buried wire, pin or rod) Excision of benign tumor or cyst of mandible; requiring intra-oral osteotomy {e.g., locally aggressive or destructive lesion (s)} Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy {e.g., locally aggressive or destructive lesion (s)} Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy {e.g., locally aggressive or destructive lesion (s)} Excision of benign tumor or cyst of maxilla; requiring extra-oral osteotomy and partial maxillectomy {e.g., locally aggressive or destructive lesion (s)}
X
X (only if billed along with
any extraction)
X
X
X