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Treating a diabetic patient with medical oral complications may be covered under the patient’s medical plan.

If you or your hygienist is now aware of the Oral connection and the changes being made you should consider sending them to the Insurance Extravaganza which is in Las Vegas. There are so many new codes that should be used in your office. With the patient’s oral health at risk, the medical portion may reimburse for certain procedures, since medical plans only pay from medical necessity the treatment must be considered medically necessary. A diabetic patient is considered high risk and if the diabetes is marginally or poorly controlled may pose greater oral complications requiring medical intervention.

Some Oral manifestations that are generally seen may include some of the following:

  • Gingivitis
  • Periodontitis
  • Disturbances of salivary secretion (Hypoptyalism, Ptyalism, Xerostomia)
  • Burning sensation in the mouth (possibly be related to neuropathy)
  • Impaired/delayed wound healing, increased incidence, and severity of infections
  • Secondary infection with candidiasis
  • Parotid salivary gland enlargement

With the above medical problems, you may consider billing the patients medical plan.

NOTE: Always check with the payer for coverage and exclusions for the patient’s medical plan.

For example, if you were to bill the dental plan you would use the Dental Code, D4210 Gingivectomy or gingivoplasty – four or more contiguous teeth or tooth bounded spaces per quadrant.

When billing the medical plan you would use the following medical codes:

  • 41872 Gingivoplasty each quadrant specify
  • K05.10 – Chronic gingivitis, plaque-induced
  • E11.630 – Type 2 diabetes mellitus with periodontal disease

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