Coding for Oral and Maxillofacial
Pathology
I. INTRODUCTION
Detailed discussion of evaluation and management (E/M) codes is not within the scope of this paper. However, this paper highlights some of the coding axioms with regard to the "global surgical package" concept.
CPT codes should be used for coding procedures related to oral and maxillofacial pathology whenever possible, but ADA or CDT (Current Dental Terminology) coding may overlap with CPT and may be preferred by some carriers. For this reason, these codes are included at the end of the paper.
Common ICD-9-CM Codes for Oral and Maxillofacial Pathology:
Common diagnostic codes for oral lesions include: 526- Diseases of Jaw
527- Diseases of the salivary gland
528- Diseases of the oral soft tissue, excluding lesions specific for gingiva and tongue
529- Diseases and other conditions of the tongue These codes are intended to point out rather common lesions.
Example of a common soft tissue lesion of the oral and maxillofacial region:
The patient presents for evaluation and treatment with the chief complaint of lesion of the lower lip. His physician refers the patient for this evaluation and treatment. The patient is a healthy 25-year-old male with an unremarkable past medical and social history.
The patient states that the lesion occurred about "3 weeks ago and goes up and then down from time to time, but never totally goes away." The patient states that this is the first time that he has experienced this type of lesion. He does not recall trauma or other injury to this area.
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The lesion has a clear-colored appearance and is soft and non-painful to palpation. The lesion feels fluid-filled and measures 5mm by 5mm by 3mm in greatest dimension. The lesion is located on the vestibular mucosa of the right lower lip, midway from the right corner of the mouth to the midline of the lower lip.
The lesion interferes with his speech and ability to chew food. The patient is concerned about the etiology and pathology of this lesion.
Diagnosis: Mucous Retention Cyst 527.6
Surgical Treatment Options:
1. Excision of lesion of mucosa and submucosa, vestibule of mouth; 40810, 40812, 40814 or 40816 depending on the extent of the surgery and repair
2. Biopsy, vestibule of mouth 40808
3. Marsupialization of the Lesion: 40801 incision of cyst, complicated
II. ICD-9-CM DIAGNOSIS CODES
The diagnosis codes for neoplasms can be found in the neoplasm table in the ICD-9-CM manual. The manual includes codes for primary and secondary malignancies, carcinoma-in-situ, benign, uncertain behavior and unspec-ified neoplasms for each site. These codes can be updated annually and as such, each surgeon must utilize updated and current coding manuals.
III. CPT CODING FOR ORAL and
MAXILLOFACIAL PATHOLOGY
The differences between Destruction, Excision, Repair and Introduction are as follows:
Destruction involves the use of a laser or electrocautery to
burn the lesion, cryotherapy to freeze the lesion, or chem-icals to destroy the lesion. The surgeon destroys benign, premalignant and malignant lesions.
Excision is when the physician makes an incision through
the skin, undermining the subcutaneous tissue beneath the lesion to remove the lesion.
Introduction is when the physician uses a syringe to inject
a pharmacological agent underneath or into skin or oral lesions (usually seven or less). The lesion may be any skin or oral lesion including post surgical scar bands. The phy-sician may inject steroids or anesthetics into these lesions.
Repair referencing CPT codes 15780 thru 15879, includes
various types of dermabrasions, chemical peels, certain types of face-lifts and some liposuction to certain areas of the body.
INTEGUMENTARY SYSTEM
This would include incision, drainage, biopsy, excision, destruction, introduction and repair referencing the follow-ing CPT codes: 10060 thru 10061 10120 thru 10180 11000 thru 11001 11010 thru 11047 11055 thru 11057 11100 thru 11101 11200 and 11201 11305 thru 11313 11420 thru 11446 11620 thru 11646 11900 thru 11901 17000 thru 17250 17270 thru 17286 17311 thru 17315
AUDITORY SYSTEM (External Ear)
This includes incision, excision and temporal bone; referencing the following CPT codes:
69000, 69005, 69020 69100 thru 69155
MUSCULOSKELETAL SYSTEM (General)
This includes incision, excision introduction or removal; referencing the following CPT codes:
20005
20200 thru 20245
20500, 20501, 20605, 20615, 20999
HEAD (Skull, Facial Bones and Temporomandibular Joint)
This includes incision, excision, introduction or removal, repair, revision, and/or reconstruction, fracture and/or dislocation, manipulation and other related procedures; referencing the following CPT codes:
21010 21015 thru 21073 21110 21181 thru 21196 21240 thru 21243 21299 21497 21499
NECK (Soft Tissues) and Thorax
This includes incision, excision, and endoscopy/arthros-copy; referencing the following CPT codes:
21501 and 21510 21550 thru 21557
ENDOSCOPY/ARTHROSCOPY
29800 thru 29804
RESPIRATORY SYSTEM (Nose and Accessory Sinuses)
This includes incision, excision, introduction, destruction, other related procedures, accessory sinuses and endoscopy referencing the following CPT codes:
30000 and 30020 30100 thru 30160 30200 30801 and 30802 30901 thru 30920 30999 31000 31020 thru 31087
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31200 thru 31230 31231 thru 31294 31299
PHARYNX, ADENOIDS AND TONSILS
This includes incision, excision and destruction; referenc-ing the followreferenc-ing CPT codes:
42700 thru 42725 42800 thru 42815
SALIVARY GLAND AND DUCTS
This includes incision, excision, repair and other proce-dures referencing the following CPT codes:
42300 thru 42699
DENTOALVEOLAR STRUCTURES
This includes incision, excision and destruction referenc-ing the followreferenc-ing CPT codes:
41800
41820 thru 41850 41870 thru 41874 41899
PALATE AND UVULA
This includes incision, excision and destruction referenc-ing the followreferenc-ing CPT codes:
42000 thru 42160
HEMIC AND LYMPHATIC SYSTEMS (Lymph Nodes and Lymphatic Channels)
This includes incision, excision and radical lymphadenec-tomy referencing the following CPT codes:
38300 thru 38305 38380
38500 thru 38555 38700 thru 38724
DIGESTIVE SYSTEM (Lips and Vestibule of Mouth)
This includes excision, incision and destruction referenc-ing the followreferenc-ing CPT codes:
40490 thru 40530 40800 thru 40801 40808 thru 40820
TONGUE AND FLOOR OF MOUTH
This includes incision and excision referencing the follow-ing CPT codes:
41000 thru 41009 41015 thru 41018 41100 thru 41155
IV. CDT CODING FOR ORAL and
MAXILLOFACIAL PATHOLOGY
D4210 Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant
D4211 Gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded spaces per quadrant
D4230 Anatomical crown exposure - four or more con-tiguous teeth per quadrant
D4241 Gingival flap procedure, including root planing - one to three contiguous teeth or tooth bounded spaces per quadrant
D4245 Apically positioned flap
D4249 Clinical crown lengthening-hard tissue D4267 Guided tissue regeneration - nonresorbable
barrier, per site, (includes membrane removal) D4268 Surgical revision procedure, per tooth
D4270 Pedicle soft tissue graft procedure D7285 Biopsy of oral tissue -- hard (bone, tooth) D7286 Biopsy of oral tissue - soft
D7310 Alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quadrant D7311 Alveoloplasty in conjunction with extractions - one to three teeth or tooth spaces, per quadrant D7320 Alveoloplasty not in conjunction with extractions -
four or more teeth or tooth spaces, per quadrant D7321 Alveoloplasty not in conjunction with extractions -
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D7410 Excision of benign lesion up to 1.25 cm D7411 Excision of benign lesion greater than 1.25 cm D7412 Excision of benign lesion, complicated D7413 Excision of malignant lesion up to 1.25 cm D7414 Excision of malignant lesion greater than 1.25
cm
D7415 Excision of malignant lesion, complicated D7440 Excision of malignant tumor-lesion diameter up
to 1.25 cm
D7441 Excision of malignant tumor-lesion diameter greater than 1.25 cm
D7450 Removal of benign odontogenic cyst or tumor-le-sion diameter up t0 1.25 cm
D7451 Removal of benign odontogenic cyst or tumor-le-sion diameter greater than 1.25 cm
D7460 Removal of benign nonodontogenic cyst or tu-mor-lesion diameter up to 1.25 cm
D7461 Removal of benign nonodontogenic cyst or tu-mor-lesion diameter greater than 1.25 cm D7465 Destruction of lesion(s) by physical or chemical
methods, by report
D7472 Removal of torus palatinus D7473 Removal of torus mandibularis
D7490 Radical resection of maxilla or mandible D7510 Incision and drainage of abscess-intraoral soft
tissue
D7511 Incision and drainage of abscess - intraoral soft tissue - complicated (includes drainage of multi-ple fascial spaces)
D7520 Incision and drainage of abscess-extraoral soft tissue
D7521 Incision and drainage of abscess - extraoral soft tissue - complicated (includes drainage of multi-ple fascial spaces)
D7530 Removal of foreign body from mucosa, skin, or subcutaneous alveolar tissue
D7560 Maxillary sinusotomy for removal of tooth frag-ment or foreign body
D7830 Manipulation under anesthesia D7840 Condylectomy
D7850 Surgical discectomy; with/without implant D7852 Disc repair
D7860 Arthrotomy D7870 Arthrocentesis
D7871 Non-arthroscopic lysis and lavage
D7872 Arthroscopy-diagnosis, with or without biopsy D7873 Arthroscopy-surgical: lavage and lysis of
adhe-sions
D7874 Arthroscopy-surgical: disc repositioning and stabilization
D7875 Arthroscopy-surgical: synovectomy D7876 Arthroscopy-surgical: discectomy D7877 Arthroscopy-surgical: debridement
D7920 Skin graft (identify defect covered, location, and type of graft)
D7921 Collection and application of autologous blood concentrate product
D7955 Repair of maxillofacial soft and/or hard tissue defect
D7960 Frenulectomy (frenectomy or frenotomy)-sepa-rate procedure
D7970 Excision of hyperplastic tissue-per arch D7971 Excision of pericoronal gingiva
D7980 Sialolithotomy
D7981 Excision of salivary gland, by report D7982 Sialodochoplasty
D7983 Closure of salivary fistula D7991 Coronoidectomy
Coding Paper
This is one in a series of AAOMS papers designed to provide information on coding claims for oral and maxillofacial surgery (OMS). This paper discusses coding for coding for oral and maxillofacial pathology. This paper is to aid the oral and maxillo-facial surgeon with proper diagnosis (ICD-9-CM) and treatment (CPT/CDT) coding for coding for oral and maxillofacial pathology. When indicated, you will be referred to the appropriate area of the coding books where the principles of coding illustrated in this paper may be applied.Proper coding provides a uniform language to describe medical, surgical, and dental services. Diagnostic and procedure codes are continually updated or revised. The AAOMS Committee on Health Care and Advocacy has developed these coding guide-lines in order to assist the membership to use the coding systems effectively and efficiently.
© 2013 American Association of Oral and Maxillofacial Surgeons. No portion of this publication may be used or reproduced without the express written consent of the American Association of Oral and Maxillofacial Surgeons.
Revised March 2013
Note: This paper should not be used as the sole reference in coding. Both diagnosis and treatment codes change frequently, and insurance carriers may differ in their interpretations of the codes.
Coding and billing decisions are personal choices to be made by individual oral and maxillofacial surgeons exercising their own profes-sional judgment in each situation. The information provided to you in this paper is intended for educational purposes only. In no event shall AAOMS be liable for any decision made or action taken or not taken by you or anyone else in reliance on the information contained in this article. For practice, financial, accounting, legal or other professional advice, you need to consult your own professional advisers.
