Coding for Oral and Maxillofacial Pathology

Transcription

1 saving faces changing lives Coding for Oral and Maxillofacial Pathology I. INTRODUCTION Detailed discussion of evaluation and management (E/M) codes is not within the scope of this paper. However, this paper highlights some of the coding axioms with regard to the "global surgical package" concept. CPT codes should be used for coding procedures related to oral and maxillofacial pathology whenever possible, but ADA or CDT (Current Dental Terminology) coding may overlap with CPT and may be preferred by some carriers. For this reason, these codes are included at the end of the paper. Common ICD-9-CM Codes for Oral and Maxillofacial Pathology: Common diagnostic codes for oral lesions include: 526- Diseases of Jaw 527- Diseases of the salivary gland 528- Diseases of the oral soft tissue, excluding lesions specific for gingiva and tongue 529- Diseases and other conditions of the tongue These codes are intended to point out rather common lesions. Example of a common soft tissue lesion of the oral and maxillofacial region: The patient presents for evaluation and treatment with the chief complaint of lesion of the lower lip. His physician refers the patient for this evaluation and treatment. The patient is a healthy 25-year-old male with an unremarkable past medical and social history. The patient states that the lesion occurred about "3 weeks ago and goes up and then down from time to time, but never totally goes away." The patient states that this is the first time that he has experienced this type of lesion. He does not recall trauma or other injury to this area. The lesion has a clear-colored appearance and is soft and non-painful to palpation. The lesion feels fluid-filled and measures 5mm by 5mm by 3mm in greatest dimension. The lesion is located on the vestibular mucosa of the right lower lip, midway from the right corner of the mouth to the midline of the lower lip. The lesion interferes with his speech and ability to chew food. The patient is concerned about the etiology and pathology of this lesion. Diagnosis: Mucous Retention Cyst Surgical Treatment Options: 1. Excision of lesion of mucosa and submucosa, vestibule of mouth; 40810, 40812, or depending on the extent of the surgery and repair 2. Biopsy, vestibule of mouth Marsupialization of the Lesion: incision of cyst, complicated II. ICD-9-CM DIAGNOSIS CODES The diagnosis codes for neoplasms can be found in the neoplasm table in the ICD-9-CM manual. The manual includes codes for primary and secondary malignancies, carcinoma-in-situ, benign, uncertain behavior and unspecified neoplasms for each site. These codes can be updated annually and as such, each surgeon must utilize updated and current coding manuals. III. CPT CODING FOR ORAL and MAXILLOFACIAL PATHOLOGY The differences between Destruction, Excision, Repair and Introduction are as follows: Destruction involves the use of a laser or electrocautery to burn the lesion, cryotherapy to freeze the lesion, or chemicals to destroy the lesion. The surgeon destroys benign, premalignant and malignant lesions. PAGE 1 Coding for Oral and Maxillofacial Pathology

2 Excision is when the physician makes an incision through the skin, undermining the subcutaneous tissue beneath the lesion to remove the lesion. Introduction is when the physician uses a syringe to inject a pharmacological agent underneath or into skin or oral lesions (usually seven or less). The lesion may be any skin or oral lesion including post surgical scar bands. The physician may inject steroids or anesthetics into these lesions. Repair referencing CPT codes thru 15879, includes various types of dermabrasions, chemical peels, certain types of face-lifts and some liposuction to certain areas of the body. INTEGUMENTARY SYSTEM This would include incision, drainage, biopsy, excision, destruction, introduction and repair referencing the following CPT codes: thru thru thru thru thru thru and thru thru thru thru thru thru thru AUDITORY SYSTEM (External Ear) This includes incision, excision and temporal bone; 69000, 69005, thru MUSCULOSKELETAL SYSTEM (General) This includes incision, excision introduction or removal; thru , 20501, 20605, 20615, HEAD (Skull, Facial Bones and Temporomandibular Joint) This includes incision, excision, introduction or removal, repair, revision, and/or reconstruction, fracture and/or dislocation, manipulation and other related procedures; thru thru thru NECK (Soft Tissues) and Thorax This includes incision, excision, and endoscopy/arthroscopy; and thru ENDOSCOPY/ARTHROSCOPY thru RESPIRATORY SYSTEM (Nose and Accessory Sinuses) This includes incision, excision, introduction, destruction, other related procedures, accessory sinuses and endoscopy and thru and thru thru PAGE 2 Coding for Oral and Maxillofacial Pathology

3 31200 thru thru PHARYNX, ADENOIDS AND TONSILS This includes incision, excision and destruction; referencing thru thru SALIVARY GLAND AND DUCTS This includes incision, excision, repair and other procedures thru DENTOALVEOLAR STRUCTURES This includes incision, excision and destruction referencing thru thru PALATE AND UVULA This includes incision, excision and destruction referencing thru HEMIC AND LYMPHATIC SYSTEMS (Lymph Nodes and Lymphatic Channels) This includes incision, excision and radical lymphadenectomy thru thru thru DIGESTIVE SYSTEM (Lips and Vestibule of Mouth) This includes excision, incision and destruction referencing thru thru thru TONGUE AND FLOOR OF MOUTH This includes incision and excision referencing the following CPT codes: thru thru thru IV. CDT CODING FOR ORAL and MAXILLOFACIAL PATHOLOGY D4210 D4211 D4230 D4241 D4245 D4249 D4267 D4268 D4270 D7285 D7286 Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant Gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded spaces per quadrant Anatomical crown exposure - four or more contiguous teeth per quadrant Gingival flap procedure, including root planing - one to three contiguous teeth or tooth bounded spaces per quadrant Apically positioned flap Clinical crown lengthening-hard tissue Guided tissue regeneration - nonresorbable barrier, per site, (includes membrane removal) Surgical revision procedure, per tooth Pedicle soft tissue graft procedure Biopsy of oral tissue -- hard (bone, tooth) Biopsy of oral tissue - soft D7310 Alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quadrant D7311 Alveoloplasty in conjunction with extractions - one to three teeth or tooth spaces, per quadrant D7320 Alveoloplasty not in conjunction with extractions - four or more teeth or tooth spaces, per quadrant D7321 Alveoloplasty not in conjunction with extractions - one to three teeth or tooth spaces, per quadrant PAGE 3 Coding for Oral and Maxillofacial Pathology

4 D7410 D7411 D7412 D7413 Excision of benign lesion up to 1.25 cm Excision of benign lesion greater than 1.25 cm Excision of benign lesion, complicated Excision of malignant lesion up to 1.25 cm D7414 Excision of malignant lesion greater than 1.25 cm D7415 D7440 D7441 D7450 D7451 D7460 D7461 D7465 D7472 D7473 D7490 D7510 D7511 D7520 D7521 D7530 D7560 Excision of malignant lesion, complicated Excision of malignant tumor-lesion diameter up to 1.25 cm Excision of malignant tumor-lesion diameter greater than 1.25 cm Removal of benign odontogenic cyst or tumor-lesion diameter up t cm Removal of benign odontogenic cyst or tumor-lesion diameter greater than 1.25 cm Removal of benign nonodontogenic cyst or tumor-lesion diameter up to 1.25 cm Removal of benign nonodontogenic cyst or tumor-lesion diameter greater than 1.25 cm Destruction of lesion(s) by physical or chemical methods, by report Removal of torus palatinus Removal of torus mandibularis Radical resection of maxilla or mandible Incision and drainage of abscess-intraoral soft tissue Incision and drainage of abscess - intraoral soft tissue - complicated (includes drainage of multiple fascial spaces) Incision and drainage of abscess-extraoral soft tissue Incision and drainage of abscess - extraoral soft tissue - complicated (includes drainage of multiple fascial spaces) Removal of foreign body from mucosa, skin, or subcutaneous alveolar tissue Maxillary sinusotomy for removal of tooth fragment or foreign body D7830 D7840 D7850 D7852 D7860 D7870 D7871 D7872 D7873 D7874 D7875 D7876 D7877 D7920 D7921 D7955 D7960 D7970 D7971 D7980 D7981 D7982 D7983 D7991 D7999 Manipulation under anesthesia Condylectomy Surgical discectomy; with/without implant Disc repair Arthrotomy Arthrocentesis Non-arthroscopic lysis and lavage Arthroscopy-diagnosis, with or without biopsy Arthroscopy-surgical: lavage and lysis of adhesions Arthroscopy-surgical: disc repositioning and stabilization Arthroscopy-surgical: synovectomy Arthroscopy-surgical: discectomy Arthroscopy-surgical: debridement Skin graft (identify defect covered, location, and type of graft) Collection and application of autologous blood concentrate product Repair of maxillofacial soft and/or hard tissue defect Frenulectomy (frenectomy or frenotomy)-separate procedure Excision of hyperplastic tissue-per arch Excision of pericoronal gingiva Sialolithotomy Excision of salivary gland, by report Sialodochoplasty Closure of salivary fistula Coronoidectomy Unspecified oral surgery procedure, by report PAGE 4 Coding for Oral and Maxillofacial Pathology

5 Note: This paper should not be used as the sole reference in coding. Both diagnosis and treatment codes change frequently, and insurance carriers may differ in their interpretations of the codes. Coding and billing decisions are personal choices to be made by individual oral and maxillofacial surgeons exercising their own professional judgment in each situation. The information provided to you in this paper is intended for educational purposes only. In no event shall AAOMS be liable for any decision made or action taken or not taken by you or anyone else in reliance on the information contained in this article. For practice, financial, accounting, legal or other professional advice, you need to consult your own professional advisers. This is one in a series of AAOMS papers designed to provide information on coding claims for oral and maxillofacial surgery (OMS). This paper discusses coding for coding for oral and maxillofacial pathology. This paper is to aid the oral and maxillofacial surgeon with proper diagnosis (ICD-9-CM) and treatment (CPT/CDT) coding for coding for oral and maxillofacial pathology. When indicated, you will be referred to the appropriate area of the coding books where the principles of coding illustrated in this paper may be applied. Proper coding provides a uniform language to describe medical, surgical, and dental services. Diagnostic and procedure codes are continually updated or revised. The AAOMS Committee on Health Care and Advocacy has developed these coding guidelines in order to assist the membership to use the coding systems effectively and efficiently American Association of Oral and Maxillofacial Surgeons. No portion of this publication may be used or reproduced without the express written consent of the American Association of Oral and Maxillofacial Surgeons. Revised March 2013 PAGE 5 Coding for Oral and Maxillofacial Pathology