D7000 – D7999 Oral and Maxillofacial Surgery
By Steven I. Snyder, D.D.S.
Introduction
Oral and maxillofacial surgery is a broad area. It encompasses not only the discipline of oral surgery, but also that of implant services, radiologic imaging, trauma, facial cosmetic procedures and anesthesia services. Some of the procedures are medical in nature and need to be submitted to medical carriers along with ICD-10-CM codes. However, there are still many procedures which are purely dental in nature.
Key Definitions and Concepts
Autogenous Graft: A graft that is taken from one part of a patient’s body and transferred to another.
Anesthesia Definitions: A patient’s level of consciousness is determined by the provider and not the route of administration of anesthesia.
Deep Sedation: A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilator function may be impaired. Patients may require assistance in maintaining a patent airway. Cardiovascular function is usually maintained.
General Anesthesia: A drug-induced loss of consciousness during which patients are not arousable. The ability to maintain ventilator function is often impaired. Cardiovascular function may be impaired.
Moderate Sedation: A drug-induced depression of consciousness during which patients respond purposefully to verbal commands either alone or accompanied by light tactile stimulation. Spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
Anxiolysis: The diminution or elimination of anxiety.
Provisional: Formed or preformed for temporary purposes or used over a limited period.
Soft Tissue Impacted Tooth: Occlusal surface of the tooth is covered by soft tissue.
Partial Bone Impacted Tooth: Part of the crown is covered by bone.
Full Bone Impacted Tooth: Most or all of the crown is covered by bone.
Five changes were made in CDT 2018’s OMS category of service – three additions and two revisions. These changes, and their rationales, follow.
These two additions fill a CDT Code gap. The rationale for their addition is that corticotomy is a procedure that is being delivered today and as there are no codes that adequately reflect the procedure it is currently reported with the unspecified by report code D7999.
D7296 corticotomy – one to three teeth or tooth spaces, per quadrant
This procedure involves creating multiple cuts, perforations, or removal of cortical, alveolar or basal bone of the jaw for the purpose of facilitating orthodontic repositioning of the dentition. This procedure includes flap entry and closure. Graft material and membrane, if used, should be reported separately.
D7297 corticotomy – four or more teeth or tooth spaces, per quadrant
This procedure involves creating multiple cuts, perforations, or removal of cortical, alveolar or basal bone of the jaw for the purpose of facilitating orthodontic repositioning of the dentition. This procedure includes flap entry and closure. Graft material and membrane, if used, should be reported separately.
There are two related sialolithotomy actions. The addition fills a CDT Code gap, with the rationale that the non-surgical removal procedure is being delivered today and should be reported with the unspecified by report code D7999, as D7980 is intended to report a surgical procedure. This addition lead to revising the D7980 nomenclature so that there is a clear differentiation between surgical and non-surgical removal procedures.
D7979 non – surgical sialolithotomy
A sialolith is removed from the gland or ductal portion of the gland without surgical incision into the gland or the duct of the gland; for example via manual manipulation, ductal dilation, or any other non-surgical method.
D7980 surgical sialolithotomy
Procedure by which a stone within a salivary gland or its duct is removed, either intraorally or extraorally.
D7111 extraction, coronal remnants – primary deciduous tooth
Removal of soft tissue – retained coronal remnants.
Diagnosis Codes – ICD-10-CM
The CDT to ICD tables in Appendix 1 provide appropriate guidance on linkages between often used Oral and Maxillofacial Surgery procedure codes and diagnosis codes. There are, in addition, ICD-10-CM codes not in these tables that may be applicable in some situations, or for procedures not listed.
|
F41.9 |
anxiety disorder, unspecified |
|
K08.12 |
complete loss of teeth due to periodontal diseases |
|
K08.13 |
complete loss of teeth due to caries |
|
K08.20 |
unspecified atrophy of edentulous alveolar ridge |
|
K08.21 |
minimal atrophy of the mandible |
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K08.22 |
moderate atrophy of the mandible |
|
K08.23 |
minimal atrophy of the mandible |
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K08.24 |
minimal atrophy of the maxilla |
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K08.25 |
moderate atrophy of the maxilla |
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K08.26 |
severe atrophy of the maxilla |
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K11.5 |
sialolithiasis |
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K11.6 |
mucocele of salivary gland |
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K12.0 |
recurrent oral aphthae |
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M26.60 |
temporomandibular joint disorder, unspecified |
CODING SCENARIO #1
Grafts – Autogenous and Non-Autogenous
A 55-year-old male who is a patient of record presented to an oral surgeon’s office six years after placement of two #12 and #13 implants. Exam revealed loss of 3 mm of attached gingiva on the buccal aspect of the implants. X-rays revealed minimal bone loss on the implants. There was one thread on each implant exposed. Along with debridement of the area, the treatment plan consisted of placing a connective tissue graft on the buccal of both implants.
How would you code for the autogenous grafts?
D4273 autogenous connective tissue graft procedure (including donor and recipient surgical sites) first tooth, implant or edentulous tooth position in graft
D4283 autogenous connective tissue graft procedure (including donor and recipient surgical sites) – each additional contiguous implant in same graft site
Note: D4273 is the code used when the procedure involves are two surgical sites, donor and recipient. The recipient site has a split thickness incision and the connective tissue is from a separate donor site leaving an epithelized flap for closure. D4283 is used to code or additional sites adjacent to the first site.
If using a non-autogenous connective graft the procedures are coded as follows:
D4275 non-autogenous connective tissue graft (including recipient site and donor material) first tooth, implant or edentulous tooth position in graft
D4285 non-autogenous connective tissue graft procedure (including recipient surgical site and donor material) – each additional contiguous tooth, implant and edentulous tooth position in the same graft site
Diagnostic Work-Up – New Patient
An 18-year-old female patient presented to an oral surgeon, referred from an orthodontist for evaluation of her mandibular retrognathia. After examination, it was noted that she had a full adult dentition in good repair with a 6 mm retrognathic mandible. In order to complete the diagnostic work-up the surgeon obtained a panoramic image, a cephalometric radiograph, models and a bite registration and extra-oral photographs.
How would you code for this visit?
D0150 comprehensive oral exam – new or established patient
The comprehensive exam is delivered because this is a new patient of record and required a thorough evaluation of both intra-oral and extra-oral hard and soft tissues. It also involves the recording of the patient’s dental and medical history.
D0330 panoramic radiographic image
D0340 2D cephalometric radiographic image – acquisition, measurement and analysis
The cephalometric image is made using a cephalostat to standardize anatomic positioning and is reproducible.
D0350 2D oral/facial photographic image obtained intra-orally or extra-orally
Possible Orbital Fracture
A 23-year-old male presents to the office after being punched in the face the night before. He has severe periorbital swelling of the left eye. The surgeon is unable to perform an adequate clinical exam and does not have a CBCT in the office but does have a cephalometric x-ray machine capable of taking a flat plate extra-oral film. He takes a Waters view film to rule-out an orbital fracture.
How do you code for this diagnostic imaging procedure?
D0250 extra-oral – 2D projection radiographic image created using a stationary radiation source, and detector
D0250 covers a class of images which can be obtained utilizing a flat plate radiographic image to view aspects of the skull and facial bones when a CBCT scan is not available.
Extraction of Full Bone Impacted Teeth
A 20-year-old male presents to the oral surgeon’s office for extraction of full bone impacted teeth #1, 16, 17 and 32. The procedure was performed utilizing deep IV sedation. The procedure lasted 53 minutes.
How would you code for the deep sedation anesthesia procedure?
D9222 deep sedation/general anesthesia – first 15 minutes
D9223 deep sedation/general anesthesia – each subsequent 15 minute increment
Report D9222 once for minutes one through 15, and D9223 three times for the additional 38 minutes (16 through 53). D9223 documents each additional full or partial 15-minute increment.
What code would be reported if 53 minutes of moderate IV sedation were appropriate?
D9239 intravenous moderate (conscious) sedation/analgesia – first 15 minutes
D9243 intravenous moderate (conscious) sedation/analgesia – each subsequent 15 minute increment
Procedure code D9239 would be reported once and D9243 three times on the claim.
What code would be reported if the extraction procedure could be performed with non-IV conscious sedation?
D9248 non-intravenous conscious sedation
This procedure would be reported once as it is not time-based.
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