D5900 – D5999 Maxillofacial Prosthetics
By Terri Bradley
The CDT Code’s Maxillofacial Prosthodontics category of service is a very unique section where the majority of the codes address procedures for devices often used for patients with cancer, trauma (such as gunshot wounds), cleft palate, etc. Due to the various medical conditions of these patients, the majority of the codes and services in this category would be submitted to medical carriers. There are, however, codes for procedures in this section that would be covered by dental carriers and not necessarily by medical carriers.
Key Definitions and Concepts
Splint: A prosthetic device which uses existing teeth or the alveolar process as points of anchorage to aid in the stabilization of broken bones (i.e., mandible, alveolar ridge) during healing. Splints are used to reestablish normal occlusion after trauma or procedures such as orthognathic surgery. These devices are stabilized by hard tissue.
Stent: A prosthetic device which is used to apply pressure to soft tissue to aid in healing and prevent scarring during healing. It can be used after surgery to aid in tissue closure and healing. Stents are often utilized for procedures post periodontal surgery, such as skin grafting.
Obturator: A prosthetic device which artificially replaces part of or all of the maxilla and associated teeth lost due to cancer, trauma or congenital defects. Obturators can be classified as interim, surgical and definitive.
Oral Prosthesis: An oral prosthesis is an artificial replacement which is either fixed or removable and aids in restoring normal form and function.
There have been no changes to this category in CDT 2018.
Diagnosis Codes – ICD-10-CM
The CDT to ICD tables in Appendix 1 do not include guidance on linkages between Maxillofacial Prosthetics procedure codes and diagnosis codes as these tables focus on claims submitted to dental benefit plans. As noted in this chapter’s introduction, Maxillofacial Prosthetics codes are often submitted to and covered by medical carriers, which do require providers to report diagnosis code(s) on the claim.
The following codes are a small sample that may be applicable. Please note that applicable ICD codes may be found in several sections of that code set, as indicated below.
C05 Malignant neoplasm of palate
C05.0 Malignant neoplasm of hard palate
C05.1 Malignant neoplasm of soft palate
G00 Diseases of the nervous system
G47 Sleep disorders
G47.33 Obstructive Sleep Apnea
K00 Diseases of the digestive system
K11 Diseases of salivary glands
Q00 Congenital malformations, deformations and chromosomal abnormalities
Q37 Cleft palate with cleft lip
Q37.1 Cleft hard palate with unilateral cleft lip
Q37.3 Cleft soft palate with unilateral cleft lip
Q37.5 Cleft hard and soft palate with unilateral cleft lip
Protecting Dentition During Cancer Treatment
A patient was recently diagnosed with cancer of the tongue and will be undergoing radiation therapy in the very near future. The patient’s oncologist suggested the patient see you to discuss ways to protect the dentition during cancer therapy. The doctor recommends fluoride trays for the patient.
How would you code this?
D5986 fluoride gel carrier
A prosthesis, which covers the teeth in either dental arch and is used daily to apply topical fluoride in close proximity to tooth enamel and dentin for several minutes daily.
CODING SCENARIO #2
Snoring and Treatment Appliances
A patient comes in stating that his wife complained his snoring is so loud at night that some nights she sleeps in the other room. He has seen his medical doctor and has been told that he does not have obstructive sleep apnea; he is just a loud snorer and his snoring seems to be worse after a high stress day. The doctor fabricates a snore guard for the patient.
How would you code for this?
Many people are unaware that the Maxillofacial Prosthetics category includes a number of non-orthodontic treatment appliances.
There is not a specific code for the snore guard but because of its similarity to these other appliances in the Maxillofacial Prosthetics category, it would be appropriate to use this code:
D5999 unspecified maxillofacial prosthesis, by report