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41899 CPT Code For Unlisted Procedure On Dentoalveolar Structure | Billing Guide

CPT code 41899 can be reported for the service when the physician performs surgery on the bony ridge that supports the teeth and gums, such as the dentoalveolar structure. Below are the description and billing guidelines for the 41899 CPT code procedures on the dentoalveolar structure.

The dentoalveolar structure denotes the soft and hard tissues of the mouth, such as the jawbone and gum.

Therefore, the surgery pertains to Dentoalveolar, explicitly focusing on alleviating or correcting oral issues that emanate from the jawbone, gum, teeth, and other structure at or below the gum line.

Reasons To Perform A Procedure On Dentoalveolar Structure

The following is why the physician performs the 41899 CPT code procedure on the dentoalveolar structure.

A patient may not have enough gum tissue to cover the roots or suffers from a medical condition that causes gums to recede.

The physician may suggest a soft tissue graft to treat the problem. In addition, they may use the patient’s or commercially available tissue to recreate the missing gum.

The patient has an impacted tooth that makes the 41899 CPT code procedure more difficult for teeth to drive through the gum line and may lead to misalignment of the teeth. In addition, the tooth may need to remove and create a space to prevent other conditions or problems.

Suppose the patient has abnormal growth, such as Cysts or Tumors in the mouth, which leads to surgical procedures. It may depend on the severity and condition of the abnormal growth, part of the gum, or jawbone.

The AMA CPT code book has a limited set of codes for dental procedure codes. CPT code 41899 is used for preventive procedures, such as:

  • dental diagnostics;
  • tooth replacements;
  • endodontic procedures (e.g., root canals);
  • dental restorations of fillings; and
  • other dental procedures when performed in an ambulatory center.

Note that this code can be used to compensate for other procedures not listed in the code book.

Suppose the patient presents to the physician’s office in the morning regarding the diabetes management service during the E/M visit CPT 99202CPT 99215.

The patient returned to the office and had a dentoalveolar structure (billed with the 41899 CPT code) later on the same day. Therefore, modifier 25 may apply with CPT code 99202 – CPT 99499 in addition to the CPT code 41899 on the same claim for E/M visits.

41899 CPT Code Description

This code can be billed for the service when the physician performs an unlisted procedure for dentoalveolar structures.

The 41899 CPT code for unlisted procedures on dentoalveolar structures is described in CPT’s manual as: “Unlisted procedure, dentoalveolar structures.”

How To Bill CPT Code 41899?

Documentation must establish the medical necessity and appropriateness of the procedures on the dentoalveolar structure.

It should reflect the patient health status and the severity of illness related to dentoalveolar structure procedure. 

If the physician administers the local anesthesia during the dentoalveolar structure procedure, CPT code 41899 may be included, but it is not allowed to report on a separate claim line.  

It is inappropriate to report his code separately for multiple times on the same claim unless the procedure is performed in exceptional circumstances.

CPT code 41899 does not apply to comparable procedures that do not reflect a similar approach or technique.

It is inappropriate to report multiple unlisted codes in combination with this code. Documentation must be relevant to the service provided by the physician. 

It is inappropriate to report the 41899 CPT code to unbundle procedures in global surgery. For instance, the surgeon performs a similar or related procedure to the dentoalveolar structure within the past 90 days.

The other procedure has 90 days global period time, and the global modifier rule applies to the CPT code 41899 to unbundle with the procedure for proper reimbursement. 

If the physician performs an unrelated service to dentoalveolar structure 41899 CPT code, it may bill with modifier 79. Similarly, a procedure related to the dentoalveolar structure and reported with modifier 78. 

The provider must contact a third-party payer or insurance before submitting unlisted code 41899 to determine whether an electronic submission is acceptable or if a paper submission is required.

The provider may require a prior authorization letter to perform the unlisted procedure for reimbursement. The insurance may need an additional letter for the refund of the service. 

The provider must compare CPT code 41899 with other related procedures and list the differences in the cover letter. They may also require the RUVS, work, and the payment of a similar service.  

Does CPT Code 41899 Need A Modifier?

The following is the list of modifiers only applicable to the 41899 CPT code in exceptional circumstances.

Modifier 59 is applicable when any other procedure may perform in combination with dentoalveolar structure CPT code 41899 that are generally not billed together on the same day. It may need modifier 59, while modifier 51 is applicable when the other procedure is not the component of the dentoalveolar structure procedure.

Modifier XS is appropriate to report with CPT code 41899 when the physician performs a separate additional procedure, such as the procedure to treat an infection of the mouth cavity.

Modifier XE attaches to the 41899 CPT code when the physician performs an additional procedure on the dentoalveolar structure on the same day but in a distinct encounter.

Modifier XP is applicable with this code when the physician furnishes the same service of the dentoalveolar structure procedure by a different practitioner on the same service date.  

Modifier XU can be reported when the physician provides the dentoalveolar structure procedure to overlapping part on the same day to unbundle other codes.

Modifier AQ may add to CPT code 41899 when the provider performs the surgery in an unlisted Health Professional Shortage Area (HPSA).

Modifier AR can be applied when the provider furnishes the surgery in the Physician Scarcity Area (PSA), such as Critical Access Hospitals (CAHs).

If the physician performs the evaluation and management visit on the same day, in addition to the dentoalveolar structure procedure, which is unrelated to the E/M service on the same day.

It is appropriate to bill E/M CPT 99201CPT 99449 with modifier 25, and the 41899 CPT code bills separately without any modifier. 

Reimbursement

CMS can not process the claim of the 41899 CPT code when the provider fails to submit the necessary information to proceed with the claim. 

The following information about procedure on dentoalveolar structures is required by insurance companies:

  • Simple extractions;
  • Full mouth extractions;
  • Surgical removal, soft tissue impacts each additional; and
  • Pediatric dental procedures.

A maximum of one unit can be a bill on the same service date of this code. In contrast, the three units allow when documentation supports the medical necessity of this procedure.

CMS may not pay for the CPT code 41889 in connection with the care, filling, treatment, removal, or teeth replacement or structures directly supporting teeth.

Is CPT Code 41899 Covered By Medicare?

According to some commercial insurances, the cost of CPT code 41899 is $1100 when performed in the ambulatory surgery center.

The price and RUVS of the CPT code are unknown for Medicare as this is an unlisted procedure. The fee may decide after a review of the service and reimburse accordingly.

Example

The following is an example of a procedure when the physician performs an unlisted procedure CPT code 41899.

Case

A 65 yo female PMH Non-insulin-dependent Type 2 Diabetes presents with heavy bleeding in the gum tissues. 

She reports that she had a root canal earlier today and also states having pain. The tooth replaces after the procedure yesterday afternoon. Afterward, she says no bleeding in the teeth and gums.

The patient has stated the severe bleeding again, and She denies fevers, chills, headaches, changes in vision, chest pain, palpitations, SOB, nausea, vomiting, arm or leg pain, numbness, and tingling. The exam, CT, and MRI revealed abnormal findings of dentoalveolar structure. 

Billing

The physician performs the CPT code 41899 to stop the bleeding of dentoalveolar structures.

It may usually perform in ordinary circumstances, leading to the patient’s blood loss. A modifier may apply with CPT code 41899 and check the appropriate payer guidelines to submit the supplementary documentation. 

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