# Dental Block



## kandigrl79

If pt. presents to the ER with a toothache and the ED physician performs a dental block, what CPT code would you use?  20600?


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## cpccoder2008

i don't think 20600 would be appropriate,, i have this same billing question, i do the billing for the physician's so i can't bill for the medicine, the only code i found that came close to what they were doing was a dental code but when i submitted it they denied for the type of provider


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## mbort

I dont know if this will work for you or not, but from an ASC standpoint, we can not use the "D" codes and have to use 41899 for all of our dental procedures, regardless of what it is.  Perhaps you can use this too?


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## cpccoder2008

mbort said:


> I dont know if this will work for you or not, but from an ASC standpoint, we can not use the "D" codes and have to use 41899 for all of our dental procedures, regardless of what it is.  Perhaps you can use this too?




what about the fee ?? i know most insurance's won't pay without medical records and you set your own fee..


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## kandigrl79

I was told to use CPT 64400 or 64402, maybe you can try this one traciecpc...


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## cpccoder2008

yeah i will have to try that


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## cpccoder2008

D9110 PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAIN-MINOR PROCEDURES 


does anyone know what this means ???


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## cpccoder2008

D9211 REGIONAL BLOCK ANESTHESIA                                                                          

D9212 TRIGEMINAL DIVISION BLOCK ANESTHESIA                                            

D9215 LOCAL ANESTHE

D9630 OTHER DRUGS AND/OR MEDICAMENTS, BY REPORT    


Are any of these appropriate ??


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## jenndeshon

*Explanations of mentioned D codes*

Per Ingenix Coding Guide to Dental Services:

D9110 Palliative (emergency) treatment of dental pain - minor procedure

       Explanation: The patient is given palliative treatment on an emergency basis for dental pain. This code is reported on a per visit basis.
      Emergent care = treatment for a medical condition or symptom (including severe pain) that arises suddenly and requires immediate care and treatment.
      Palliative treatment = treatment of symptoms without treating the underlying cause or to maintain current health status.

D9211 Regional block anesthesia
      Explanation: Report D9211 if the dentist administers a regional anesthetic block through a similar injection process (as local anesthesia) for pain control. Regional nerve blocks are given close to a main nerve trunk at a distance from the operative/treatment site. Examples of regional nerve blocks are nasopalatine injections, posterior superior alveolar, infraorbital, and inferior alveolar injections.
      Nerve block = a type of regional anesthesia/analgesia administered by injection that prevents sensory nerve impulses from reaching the central nervous system.


D9210 Local anesthesia not in conjunction with operative or surgical procedures
      Explanation: Local anesthetics are given into small nerve endings in the same area in which the incision or dental treatment is made. Topical antiseptic and/or topical anesthetic may be applied to the area first. With a sterilized needle and the patient in position, the dentist inserts the needle into mucosa, injects several drops of local anesthetic solution, and begins slowly advancing toward the target.
      Local anesthesia = an induced feeling or sensation restricted to a certain area of the body, including topical, local tissue infiltration, field block, or nerve block methods.


Associated CPT codes
      01995  Regional intravenous administration of local anesthetic agent or other medication (upper or lower extremity)
      90784  Therapeutic, prophylactic or diagnostic injection (specify material injected); intravenous


HCPCS Codes
      J0670  Injection, mepivacaine HCl, per 10 ml
      J2400  Injection, chloroprocaine HCl, per 30 ml
      S0020  Injection, bupivacaine HCl, 30 ml

Hope this helps! Without knowing what is in the documentation, it would be difficult to guess which code is correct. 

Good luck!
Jennifer, CPC


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## cpccoder2008

it sound to me like D9110 Palliative (emergency) treatment of dental pain - minor procedure would be the appropriate one, thats the one i tried billing but got denied for type of provider. my physician doesn't give much information on the progress note, just that they injected the patient with either lido or something similiar to that, for a dental block. Just till the patient can see a dentist. They don't actually remove the tooth or treat the problem, they just give a dental block


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## kandigrl79

I don't think any of the dental codes will work for ED.  I believe these codes are just for dentists (sometimes they do emergency procedures I think), so maybe that's why that code was denied when you billed it.


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