Coding for Orthognathic Surgery - American Association of Oral and ...

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D. There are CDT codes for Cone Beam imaging [also called 3-D Imaging] which may be applicable in the radiographic assessment of some patients: Coding Paper Cone beam – three-dimensional image reconstruction using existing data, includes multiple images Image with Interpretation Cone beam CT capture and interpretation with limited field of view - less than one whole jaw Cone beam CT capture and interpretation with field of view of one full dental arch-mandible Cone beam CT capture and interpretation with field of view of one full dental arch-maxilla, with or without cranium Cone beam CT capture and interpretation with field of view of both jaws with or without cranium Cone beam CT capture and interpretation for TMJ series including two or more exposures Image Capture Only Cone beam CT image capture with limited field of view- less than one whole jaw Cone beam CT image capture with field of view of one full dental arch- mandible Cone beam CT image capture with field of view of one full dental arch-maxilla, with or without cranium Cone beam CT image capture with field of view of both jaws, with or without cranium Cone beam CT image capture for TMJ series including two or more exposures PAGE 2 Coding for Orthognathic Surgery D0363 D0364 D0365 D0366 D0367 D0368 D0380 D0381 D0382 D0383 D0384 E. There is a family of new codes that represent procedures sometimes employed when managing patients with skeletal malocclusions, or other dentoalveolar disorders. All three codes provide skeletal anchorage and include device removal: 1. Surgical Placement – temporary anchorage device [screw retained plate] requiring surgical flap 2. Surgical Placement – temporary anchorage device requiring surgical flap 3. Surgical Placement – temporary anchorage device without surgical flap D7292 D7293 D7294 F. There is a code for intraoral fixation device that applies to “the placement of an intermaxillary fixation appliance used for documented medically accepted treatments not in association with fractures.” Intraoral placement of a fixation device not in conjunction with a fracture This CDT code is similar to CPT code 21110 D7998 III. DIAGNOSIS CODES (ICD-9-CM MANUAL VOLUMES 1 AND 2) Note: ICD-9-CM diagnostic coding conventions require the surgeon to report diagnosis codes to the highest level of specificity (use of a five-digit code rather than a fourdigit code). A. ICD-9-CM code ranges for orthognathic surgery: 1. Major anomalies of jaw size (524.00 -524.09). Codes 754.0 and 526.89, discussed in paragraph B below, are specifically excluded from this section. 2. Anomalies of relationship of jaw to cranial base (524.10 – 524.19) 3. Anomalies of dental arch relationship (524.20 – 524.29) 4. Malocclusion, unspecified 524.4 (no 5th digit) 5. Dentoalveolar anomalies (524.70 – 524.79) 6. Other acquired deformity of the head (738.10 – 738.19)
B. ICD-9-CM codes for Syndromes and Conditions Requiring Orthognathic Surgery Some orthognathic cases may result from syndromes and conditions requiring the surgeon to use the following codes as primary diagnoses in tandem with the developmental codes listed above (see Section IIIA). In such cases, the developmental codes will represent secondary diagnoses. These syndromes are listed below, followed by a parenthetical code and descriptor. 237.7 Neurofibromatosis/von Recklinghausen’s disease (see mandibular asymmetry: Hyperplasia-524.02, or Hypoplasia-524.04) (5th digit required) 253.0 Acromegaly (see mandibular hyperplasia-524.02) 282.4 Thalassemia (see unspecified acquired deformity of head 738.10) (5th digit required) 346.8 Mobius syndrome (see mandibular hypoplasia-524.04) 520.5 Amelogenesis imperfecta (see alveolar maxillary hyperplasia-524.71, and also mandibular hyperplasia-524.02 usually, both of these codes will be required for secondary diagnosis of amelogenesis imperfecta) 526.89 Unilateral condylar hyperplasia or hypoplasia of mandible (since this is the only code for the condyle, there is no secondary code) 733.3 Hyperostosis of Skull (includes Stewart- Morel syndrome and Leontiasis ossium) 733.81 Malunion of fracture (see the appropriate developmental diagnosis) (also use late effect code 905.0) 733.82 Nonunion of fracture (see the appropriate developmental diagnosis) (also use late effect code 905.0) 754.0 Hemifacial atrophy or hemifacial hypertrophy (see the appropriate developmental diagnosis or see unilateral condyle hyperplasia or hypoplasia or mandible) Coding Paper 755.55 Apert’s syndrome/ Acrocephalosyndactyly (see maxillary hypoplasia-524.03) Pfeiffer syndrome (see maxillary hypoplasia-524.03, and unspecified acquired deformity of head-738.10) 755.59 Cleidocranial Dysplasia/ Cleidocranial Dysotosis (see maxillary hypoplasia-524.03, and also alveolar maxillary hyperplasia-524.71) 756.0 The following syndromes fall under ICD 9 CM 756.0 [no 5th digit]: Crouzon’s disease (Craniofacial dysostosis) (see maxillary hypoplasia-524.03, and also unspecified acquired deformity of head-738.10) Goldenhar syndrome/Hemifacial Microsomia (see mandibular hypoplasia-524.04, and also microgenia-524.06) Hallermann-Streiff syndrome (see mandibular hypoplasia-524.04, and also microgenia-524.06) Robin Complex/Pierre-Robin syndrome/ Robin Anomalad (see mandibular hypoplasia-524.04, and also microgenia-524.06) Treacher-Collins syndrome/ Mandibulofacial Dysostosis (see zygomatic hypoplasia-738.12, Mandibular Hypoplasia-524.04, and also unilateral condyle hypoplasia-526.89. Note: Use all secondary codes) 756.4 Achondroplasia (see maxillary hypoplasia-524.03) 756.51 Osteogenesis Imperfecta (see mandibular hyperplasia-524.02) PAGE 3 Coding for Orthognathic Surgery
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