Our office will file your claim on your behalf. If you would like to file a claim on your own, please follow along the instructions below.
Do you have a dental PPO (preferred provider organization) insurance plan? If you do, your dental insurance plan may cover a large portion of your services at South Austin Oral Surgery. Dental PPO plans allow you to see out-of-network providers like us and be reimbursed for the treatment you receive. Some PPO insurance plans cover 50-80% out-of-network fees. With our low fees, you may even find the total amount you pay is comparable to that of an in-network provider. Please note, if you have a HMO/DMO, Medicaid, or Medicare dental insurance, you may see us, but will not be reimbursed by your insurance plan.
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Documentation
Most patients are coming to South Austin Oral Surgery to have a tooth extracted for a reason – in our opinion, rarely considered an elective procedure. Your insurance company may say that treatment is covered as long as we code it correctly or say it is “medically necessary.” Your insurance company will have a definition of what they consider medically necessary. Medical necessity is NOT dependent on my opinion. Ask your insurance company the specific criteria to determine medical necessity. They may require a specific diagnosis and treatment code before they consider something medically necessary. We can only code for a diagnosis consistent with our findings and treatment we have completed.
Every time you speak with an insurance company employee, you need to take notes. Make sure you record the following and keep it in a safe place:
- Date and time of the call.
- Name of the employee you spoke with.
- “Reference number” for the call. Your insurance company gives a reference number to every call and critical for you to document.
Filling Out the 2019 Dental Claim Form
1 – If you have received treatment, this will be pre-checked to Statement of Actual Services. If you would like to obtain a pre-authorization, check Request for Predetermination/Preauthorization instead. While an insurance company will generally honor their pre-authorization, there have been instances where they have gone back and denied a claim. Many plans also have limits to how much they cover each year. Depending on if you have had other dental work between the pre-authorization and treatment, coverage may change as well.
2 – If you are submitting a claim pre-authorized by your insurance company, enter the authorization number here when you are actually submitting your claim.
3 – Enter the name and address of your your dental insurance company here. If you have more than one insurance plan, enter the primary insurance company’s information here for the initial claim.
4-11 – If you have coverage under another dental or medical plan, you will need to fill out this information. If you are only filing with your primary dental insurance plan, this section may be left blank.
12-17 – Fill this part out with the name and policy information of the person in your family that the dental insurance in #3 is under. This information is often on your insurance card.
18-23 – Fill this out with the information of the patient who was treated at our office. Leave #19 and #23 blank.
24-35 – This will be filled out for you by our office if you have received treatment. If you are sending in a preauthorization, the information will be found in the treatment plan provided to you. For section #26, any item that has a tooth description should have “JP” placed as the Tooth System. For oral surgery, the pertinent sections will be #27, 29, and 30.
29, 34a – Common codes used by our oral surgery office. See next section.
After your submission, your dental or medical insurer is expected to pay or respond to you within 30 days of an electronic claim or 45 days for a paper claim. If you have not heard from that in that time, contact them or the Texas Department of Insurance regarding this issue. There are penalties for insurance companies for not corresponding or paying within these timeframes.
If you need any additional documents or paperwork from our office, email us and we will be happy to help you with your claim.
Common CDT and Corresponding ICD-10 Codes
| CDT Codes(s) | ICD-10 Codes |
| Extractions of Erupted Tooth and Bone Graft D7111 – extraction of primary tooth, coronal remnants D7140 – extraction erupted tooth or exposed root D7210 – surgical removal of erupted tooth D7250 – surgical removal of residual tooth roots D7950 – onlay graft, guided bone regeneration D7953 – bone replacement graft for ridge preservation D4266 – guided tissue regeneration – resorbable membrane D4267 – guided tissue regeneration – non-resorbable membrane | K02.53 – dental caries on pit and fissure surface penetrating into pulp K02.63 – dental caries on smooth surface penetrating into pulp K03.81 – cracked tooth K03.9 – disease of hard tissues of teeth, unspecified K04.0 – pulpitis K04.1 – necrosis of the pulp K04.5 – chronic apical periodontitis K04.6 – periapical abscess with sinus K04.7 – periapical abscess without sinus K04.8 – radicular cyst K04.9 – other and unspecified diseases of pulp and periapical tissues K05.20 – aggressive periodontitis, unspecified K05.21 – aggressive periodontitis, localized K05.30 – chronic periodontitis, unspecified K09.0 – developmental odontogenic cysts L02.91 – cutaneous abscess, unspecified L03.90 – cellulitis, unspecified M27.51 – perforation of root canal space due to endodontic treatment S02.5XXA – fracture of tooth (traumatic), initial encounter for closed fracture S02.5XXB – fracture of tooth (traumatic), initial encounter for open fracture S03.2XXA – dislocation of tooth; initial encounter |
| Surgical Removal of Impacted Teeth D7220 – extraction of soft tissue impacted tooth D7230 – extraction of partial bony impacted tooth D7240 – extraction of full bony impacted tooth D7251 – coronectomy – intentional partial tooth removal | K00.1 – supernumerary tooth K00.6 – disturbances in tooth eruption K01.0 – embedded teeth K01.1 – impacted teeth K09.0 – developmental odontogenic cysts |
| D7280 – surgical exposure for orthodontics D7282 – tooth mobilization for eruption | K00.6 – disturbances in tooth eruption K01.1 – impacted teeth |
| Dentoalveolar/Pre-prosthetic Surgery D7310 – alveloplasty with extractions D7311 – alveloplasty with extractions, 1-3 teeth D7320 – alveloplasty without extractions D7321 – alveloplasty without extractions, 1-3 teeth D7471 – removal of exostosis, per side D7472 – removal of maxillary torus D7473 – removal of mandibular torus, per side D7960 – frenulectomy | |
| Sedation and Anesthesia D9222 – IV deep sedation, first 15min D9223 – IV deep sedation, each incremental 15min D9239 – IV moderate sedation, first 15min D9243 – IV moderate sedation, each incremental 15min D9610 – parenteral drug, 1 med D9612 – parenteral drugs, 2+ meds D9248 – oral/IM/non-IV sedation | F41.9 – anxiety disorder, unspecified |
| Neurotoxin Injections 64611 – chemodenervation of parotid and submandibular salivary glands, bilateral 64612 – chemodenervation of facial muscles, unilateral 64615 – chemodenervation of facial muscles, bilateral 64616 – chemodenervation of neck muscles, unilateral 64999 – unlisted procedure, nervous system | J0585 -injection, onabotulinumtoxinA (Botox), 1 unit J0586 – injection, abobotulinumtoxinA (Dysport), 5 units J0587 – injection, rimabotulinumtoxinB (Myobloc), 100 units J0588 – injection, incobotulinumtoxinA (Xeomin), 1 unit G47.63 – sleep related bruxism M26.60 – tempormandibular joint disorder, unspecified M79.11 – myalgia of mastication Z41.1 – encounter for cosmetic surgery |