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Hi-
I am in an Oral & Maxillofacial surgery office where we mostly do Orthognathic surgery and joint replacements. We bill medical insurance for surgery. The Doctor does pre-surgical planning using a CBCT and digital (optical scan) models. Then a surgical splint is printed by a company using a 3D printer. WE are needing to know how we can bill and get reimbursed for the fabrication and surgical planning. Currently, we use CPT 21085, however im trying to figure out if there is a better/additional code that will reimburse for the surgeons time for the planning session. Would it be considered a DME?? We have to pay the planning company for the splint ahead of time.
Thank you!
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Hi Guest!
Great question. 21085 stands for: Impression and custom preparation; oral surgical splint
This code does typically include the preparation & fabrication of the splint, and we do not typically see it categorized as DME.
A code you may consider for the additional planning time is:
99358 - Prolonged evaluation and management service before and/or after direct patient care; first hour
The notes on this code indicate: Report this service if the provider spends time in either preparation or evaluation of the outcome of treatment before or after the face–to–face encounter with a patient.
Hope this helps!
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Rank: Guest
Joined: 9/8/2012(UTC)
Posts: 54,136
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Yes, we use 21085 currently for the fabrication/preperation of the splint! Thank you so much for your reply, i think 99358 is EXACTLY what we are looking for!
You're amazing! I appreciate it!
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Rank: Guest
Joined: 9/8/2012(UTC)
Posts: 54,136
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Is it possible to bill 21085 in out patient setting
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