When your patient presents with an injury, specific ICD-10 codes are available for trauma to the teeth, temporomandibular joint (TMJ) or lip, tongue cut that need attention. In addition to the diagnosis, it is important to document the accident as soon as possible and to contact the insurer to start a case file. Time must be fast since some accident policies will not pay unless the claim is put in fast and the patient must be seen within 1-2 days following an accident or incident. If they were not able to come into your practice as fast but had other injuries, then getting the claim numbers that were filed from the first claim is necessary. Insurers may also stipulate that the treatment be completed within 1 year (time limits vary from 6 months to 2 years or more). I have had longer for many claims if they are children who cannot have treatment completed since they are still in the growing stage. You must document that and explain that you will see the patient follow ups until treatment can be completed. Contact the insurer as soon as possible with a written treatment plan and a narrative report outlining the accident in the patient’s words. Also, imaging may be required as documentation for accident cases. Here are some quick tips for accident billing for TMJ and tooth trauma.
Accident codes are specific, there are thousands available!
My last case was at a meeting and the office brought with them a patient of the practice who was coaching baseball and was hit in the mouth, jaw with ball. He has three fractured teeth and the CBCT Scan showed jaw dislocation.
To communicate the diagnostic story and exactly what happened, list the code to describe the condition first, then the specific incident & lastly, supporting codes for place of occurrence.
K08.81 – Primary occlusal trauma
Occlusal trauma is an injury which displaces a tooth or alveolus (socket), causing abnormally large tooth spaces and teeth crowing. There are two types of trauma coding rules.
In this case it is primary since it is due to the injury.
- Primary: Specifically due to the injury
- Secondary: The tooth or alveolus was already experiencing a disease/condition which weakened the attachment and experiences a normal force which displaces the tooth. If the tooth were healthy, the force would not displace it, but because it has been weakened, it moves.
- Fracture of tooth – hit by baseball bat W21.11XA – Struck by baseball bat, initial encounter.
- Y92.320 – Baseball field as the place of occurrence of the external cause
- M26.603 – Bilateral temporomandibular joint disorder, unspecified (this is included in the accident for treatment
You must include a complete reading of any X-Rays or CBCT Scans to provide the insurance with the information needed without the x-rays. Medical wants written documentation.
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