Coding is crucial in healthcare billing since insurance companies always reject claims with incorrect coding. The validity of a claim will be hampered by inaccurate coding and billing. (Jyothi M Borkar, Manjunatha R, 2019) Insurance carriers accept only claims with proper codes, and only those charges are paid. Similar to this, practically all insurance companies demand officially proper coding when it comes to oral appliances for treating temporomandibular joint or temporomandibular disorders to pay the income.
Temporomandibular disorders (TMDs) are a set of ailments that affect the temporomandibular joint (TMJ), muscles of mastication, and associated tissues. (Akshat Sachdeva, Sumit Bhateja, Geetika Arora, Brinda Khanna, Archika Singh, 2020) TMD affects a significant section of the world’s population, with 25% of adults reportedly having indications or symptoms. (Perez, C.V.; de Leeuw, R.; Okeson, J.P.; Carlson, C.R.; Li, H.-F.; Bush, H.M.; Falace, D.A., 2012)
An oral appliance is used to relieve jaw discomfort. In addition to allowing the muscles to work effectively, this could also adjust the lower jaw to fit correctly into the TMJ socket. By altering the strain placed on the TMJs, OAs reduce mechanical stress and joint inflammation. (Harold f Menchel, Charles S Greene, Kevin D. Huff, 2021) Your dental insurance claim will be processed accurately and quickly if the proper code is entered. In order to submit a claim, you are supposed to know the codes for TMD/TMJ appliances so that you can apply the correct code, and your claim will not be rejected. In order to understand the most commonly used codes, pay heed to the codes given below.
CPT codes for billing TMD/TMJ appliances
Common CPT codes for orthotics
Orthotic Appliances are detachable implants that fit over the occlusal surfaces of the maxillary or mandibular teeth. They are typically composed of durable acrylic material.
- S8262: Mandibular Orthopedic Repositioning Device, each. But now, this code has been discontinued. When this temporary code was discontinued, doctors searched for other alternative codes. Today, the codes being used are:
- D7880: Occlusal orthotic device (by report) provided to treat TMJ dysfunction.
- D7889: Unspecified Temporomandibular therapy. (by report)
- 21299: Unquoted craniofacial and maxillofacial procedure accompanied with a report (Dental Writer SOAP report of medical necessity)
- 21499: Unlisted musculoskeletal procedure, head
- E1399: Miscellaneous durable medical devices (only used when the insurers consider temporomandibular disorder as durable medical equipment, which is rare)
CDT codes for occlusal appliances
An occlusal appliance, also known as a bite guard, night guard, or interocclusal appliance, is a detachable appliance often composed of hard acrylic. Using these appliances, you can shield your teeth from various ailments. Moreover, it aids in lessening bruxism’s unpleasant and occasionally painful symptoms. Additionally, dentists may suggest gadgets to cure teeth grinding and clenching, and avoid damaged teeth. Intraoral occlusal implants aim to ensure balanced and even occlusal contact without forcibly changing the mandibular resting position or the dental occlusion over the long term. (Sameh A Seifeldin and Khaled A. Elhayes, 2015) Treatments that are reversible and non-invasive include occlusal guards and occlusal splints.
The American Dental Association creates CDT codes, which are dental codes. A unique, international code is used for every dental or oral operation to maintain consistency in documentation. These codes streamline treatment filing and insurance claims, reduce inaccurate reporting, and reduce the demand for additional paperwork from dental facilities. The ICD-10 codes are a crucial component of your medical report; therefore, using them in both your statements of medical necessity and your clinical information for TMD would be essential.
- D9946: Occlusal guard (for the hard appliance, partial arch)It reduces the adverse consequences of “tooth clenching” and “bruxism.”
- D9943: Occlusal guard adjustment Occlusal adjustment entails moving the mandible to a focal position using orthodontic or prosthodontic devices. (Sameh A Seifeldin and Khaled A. Elhayes, 2015)
- D9945: Occlusal guard (for the soft appliance, entire arch)
- D9942: Repairing or relining of occlusal guards
- D9944: Occlusal guard (for the hard appliance, entire arch)
Any sleep apnea, snoring, or TMD appliances should not be recorded using the D9944, D9945, or D9946 codes. The American Dental Association (ADA) advises that any complete or partial arch guards with a challenging occlusal component, regardless of whether they also contain a soft appliance, should be coded as rigid guards—D9944 for a complete arch appliance and D9946 for a partial arch appliance.
Common ICD diagnostic codes for splints
One conservative method of treating temporomandibular joint diseases is splint treatment. (M P Santhosh Kumar, 2021) Patient with TMD who exhibit signs and symptoms of discomfort and restricted mandibular mobility may benefit from using an occlusal splint as a non-invasive therapy option. (Si-Hui Zhang, Kai-Xun He, Chen-Jing Lin, Xiang-Dong Liu, Ling Wu, Jiang Chen,Xiaohui Rausch-Fan, 2020) Stabilization splints, a type of TMJ appliance, are the most effective, sensible, and evidence-based therapy for lasting improvements. The stabilization splints are made to separate the back teeth during protrusion and to raise the canine during lateral excursions. (Preeti Agarwal Katyayan, Manish Khan Katyayan, […], and Ghanshyam Patel, 2014) TMJ specialists prescribe, develop, install, and modify these devices, often known as bite plates or guards.
- 729.1: Myositis, Myalgia, Myofascitis
- 784.0: Headache, cephalgia, face pain
- 350.2: Atypical facial pain
Does medical insurance pay for adjustments?
Adjustments made within six months of the start of appliance treatment are often regarded as medically necessary for insurance policies that cover orthotics. Four adjustments are frequently given if a patient requires extensive appliance therapy following the first appliance implantation, which typically takes a year. It is said that dentists must prove a patient’s need for dental care when they treat them to persuade the insurance firm to pay for the procedures they give. (Patti DiGangi, Christine Taxin, 2014)
It’s simpler than you would think to select the proper treatment code if you understand the guidelines. Understanding these guidelines and a few widely used codes might be advantageous. The objectives for your patient’s dental health will be easier to meet. The treatments will give most patients pain relief and a more acceptable jaw posture. It is advantageous for everyone when laws and treatment guidelines are followed since your clinic will get payments more quickly.
MedsDental billing company is the best choice for your practice
It is usually preferable for dental offices to contact the patient’s dental insurance company to find out what services are covered by the patient’s insurance and how much. Experienced dental billing companies can verify the eligibility of each patient flawlessly. As a result, the MedsDental Dental Billing Company is prepared to support you in ensuring your patients have insurance to maintain a steady payment flow for the services rendered. We efficiently verify insurance, submitting accurate claims with appropriate code using cutting-edge technology and HIPAA-compliant services. Our coders thoroughly understand and keep up with coding modifications for night guards and any other occlusal appliance to guarantee that the practice is adequately compensated. So, make a partnership with us by outsourcing your billing section so that you can focus on your treatment without overwhelming about appropriate billing. Contact us any time of the day, and we guarantee you will be pleased by our services.