Oral Surgery Coding & Reimbursement Alert
Thinking of Multiple Units of 41899? Not so Fast
Question: I am trying to report a full mouth oral rehabilitation that our surgeon performed. Since there is no code to describe the procedure, I am planning to report the unlisted code, 41899 for the procedure. But, I am wondering whether to report one unit of the code for each tooth that was corrected or should I just report one unit of the code for the entire procedure?
Michigan Subscriber
Answer: You are right that you do not have any straightforward CPT® code that you can use to describe a full mouth oral rehabilitation. You will instead have to use the unlisted procedure code 41899 (Unlisted procedure, dentoalveolar structures) for the procedure.
Since you are reporting an unlisted code for the procedure, it is best to only report it once for the entire procedure rather than listing it for each and every correction procedure that your surgeon carried out. This is due to the fact that the unlisted code does not indentify a specific unit value or service. Unit values are not assigned to unlisted codes since the codes do not identify usual procedural components or the effort/skill required for the service.
So, if you are reporting this service to the medical insurance carrier, report 41899 only once for the entire procedure and provide adequate documentation listing each and every procedure that your clinician carried out for the rehabilitation.
Since the unlisted code does not carry any relative value units (RVUs), it is best that you include details of reimbursement that you would expect for the procedure so that it does not get allocated without any basis. If you fail to do this, then you might not get deserved payment towards the procedure performed.
Coding tip: Since oral full mouth rehabilitation involves tooth related work mainly, it is best to report this service to the dental insurance provider rather than a medical insurance provider. If the rehabilitation is being provided as a part of another medical related service (such as a surgery or trauma service), you can report the dental related service also as part of the other medical related service.
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