The Diabetic Patient and Medical Manifestations

December 20th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Categories:   CPT® Coding   Dental   Diagnosis Coding  
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Treating a diabetic patient with medical oral complications may be covered under the patient's medical plan. With the patient's oral health at risk, the medical portion may reimburse for certain procedures, since medical plans only pay from medical necessity the treatment must be considered medically necessary. A diabetic patient is considered high risk and if the diabetes is marginally or poorly controlled may pose greater oral complications requiring medical intervention.

Some Oral manifestations that are generally seen may include some of the following:

  • Gingivitis
  • Periodontitis
  • Disturbances of salivary secretion (Hypoptyalism, Ptyalism, Xerostomia)
  • Burning sensation in the mouth (possibly be related to neuropathy)
  • Impaired/delayed wound healing, increased incidence, and severity of infections
  • Secondary infection with candidiasis
  • Parotid salivary gland enlargement

With the above medical problems, you may consider billing the patients medical plan.

NOTE: Always check with the payer for coverage and exclusions for the patient's medical plan.

For example, if you were to bill the dental plan you would use the Dental Code, D4210 Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant.

When billing the medical plan you would use the following medical codes:

41872 Gingivoplasty each quadrant specify

K05.10 - Chronic gingivitis, plaque-induced

E11.630 - Type 2 diabetes mellitus with periodontal disease

 

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