Implants

Dental Implant codes


The selection of diagnosis codes pertaining to the presenting symptoms and conditions is what sets the tone for billing of the procedure. The diagnosis codes should be selected from both the primary presenting situation(s), as well as from secondary, or supporting, diagnoses for the treatment to be provided. All surgical claims require pre-authorization from the medical plans, and this must be done before the procedure is performed. According to the American Medical Association (AMA), it is also recommended that a Letter of Medical Necessity be submitted via fax to obtain written verification of coverage and to confirm that the treatment has undergone medical review and was deemed “medically necessary.”

All surgical claims require pre-authorization from the medical plans, and this must be done before the procedure is performed.

The diagnosis codes must be listed in the correct order, both in the Letter of Medical Necessity and on the claim form. Start the list with the most important presenting condition and continue in descending order, followed by any V and/or E codes specifying contributing medical history factors, if present. The lack of a greater medical condition does not negate the medical necessity of the procedure. In deciding the order, keep in mind that the first diagnosis listed must relate to the most important or most expensive procedure to be performed and that only four diagnosis codes are allowed. All medical claims must contain diagnosis codes or they will not be considered for payment.

Keep in mind that the first diagnosis listed must relate
to the most important or most expensive procedure to be performed.

Primary Diagnosis codes

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CHOOSING THE APPROPRIATE PROCEDURE CODES (CPT)



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