Subject	Coding Review: TMJ Disorders
Source	AAOMS Newsletter
Publication	Coding Corner- July/August 2009
Effective Date	Jul 20, 2009
Publish Date	Jul 20, 2009

CODING REVIEW: TMJ Disorder

The AAOMS Committee on Health Care and Advocacy (CHCA) was recently asked to review available diagnostic and treatment codes for various TMJ disorders. These include ICD-9-CM codes for diagnosis and CPT and CDT codes for treatments rendered.

ICD-9-CM codes for various disorders are listed below, loosely grouped into categories.

Coders are advised that when available, the fourth and fifth digits are required to be used and to always use codes from the most current ICD-9-CM manual, which is the official source of coding guidelines.

For all TMJ disorders, the code TMJ disorder, unspecified 524.69 may be used if no other more specific code applies. 

For disorders involving the masticatory muscles, one or more of the following codes may apply:

    Diffuse diseases of connective tissue - 710.9

    Myositis- 728.81

    Muscle spasms -728.85

    Myalgia  -729.1

For internal derangement, use:

    TMJ adhesions- 524.61

    TMJ arthralgia - 524.62

    TMJ disc derangement0 -524.63

    TMJ dislocation 524.69 (recurrent) 830.0 or 830.1 (excludes recurrent)

    TMJ sprain / strain - 848.1

For degenerative joint disease, codes that might apply are:

     Diffuse disorder of connective tissue 710 (followed by the appropriate fourth digit)

For arthropathies associated with other disorders classified elsewhere, use 713 (followed by the appropriate fourth digit)

    Rheumatoid arthritis - 714.0

    Juvenile chronic polyarthritis - 714.3 (followed by the appropriate fifth digit)

    Osteoarthrosis - 715 (followed by the appropriate fourth and fifth digits)

    Other unspecified arthropathy - 716 (followed by the appropriate fourth and fifth digits)

    Gouty arthritis - 274.0

For TMJ partial or complete TMJ ankylosis, use:

      TMJ ankylosis/ adhesions - 524.61

      Other specified TMJ disorder - 524.69

      Ankylosis of specified site - 718.58 (excludes jaw 524.60 - 524.69)

Other miscellaneous codes may include:

       Unilateral condylar hyperplasia/ hypoplasia - 526.89

       Coronoid hyperplasia - 526.89

       Major osseous defect - 731.3 (could be used for post trauma defect - code also the underlying disease or trauma that resulted in the osseous defect, if known)

       Foreign body in bone - 733.99

OMS descriptor codes for various treatments may be either medical codes (CPT) or dental codes (CDT). Below you will find listed many of the codes that may apply.  Depending on a patient's coverage there may be occasions where the claim is submitted to medical using CPT codes, to dental using CDT codes or times where medical and dental coordinate.

Some of the codes that are included in the CPT system are:

     Closed treatment of TMJ dislocation - 21480 or 21485

      Open treatment of TMJ dislocation - 21490

      Splint therapy - 21085 or 21089 (if the OMS is fabricating the splint himself/herself in the office, not by an outside laboratory) or 99070 with an invoice (if fabricated by an outside laboratory)

     Non- Arthroscopic lysis and lavage, use unlisted craniofacial and maxillofacial  procedure 21299 followed by the  arthrocentesis, aspiration or injection code 20605, or use the dental code below which is a more specific code

     If an injection is performed, report using - 99070

     If an aspiration is performed and the specimen is packaged and sent to an outside laboratory, use - 99000

    Arthrocentesis - 20605

    Arthroscopy-diagnostic - 29800

    Arthroscopy-surgical - 29804

    Arthroplasty - 21240

    Arthroplasty with biopsy - 21240

    Arthroplasty (joint reconstruction) with allograft - 21242

    Arthroplasty with prosthetic joint replacement - 21243 

    Reconstruction of mandible with bone and cartilage autograft - 21247

    Condylectomy - 21050

    Discectomy - 21060

    Coronoidectomy/ coronoidotomy - 21070 

    Mandibular condylotomy / Vertical ramus osteotomy - 21193

    Application of maxillomandibular fixation - 21110

    Osteotomy of the zygomatic arch - 21188

    Mandibular osteotomy without rigid internal fixation - 21195

    Mandibular osteotomy with rigid internal fixation  - 21196

    Removal of failed implant  - 20670 / 20680

    Manipulation of TMJ requiring general anesthesia or MAC - 21073

 

OMS codes that are included in the CDT system are:

     Manipulation under anesthesia  - D7830

     Arthroscopy-diagnostic - D7872

     Arthroscopy-biopsy- D7872

     Non-arthroscopic lysis and lavage-  D7871

     Arthroscopy-disc repositioning - D7874

     Arthroscopy-synovectomy - D7875

     Arthroscopy -discectomy - D7876

     Arthroscopy - surgical debridement  - D7877

     Arthrotomy - D7860

     Arthroplasty - D7865

     Arthroplasty-condylectomy - D7840

     Arthroplasty-discectomy without replacement  - D7850

     Arthroplasty-disc repair - D7852

     Arthroplasty-joint reconstruction - D7858

     Open reduction of TMJ dislocation - D7810

     Ramus osteotomy - D7941

     Ramus osteotomy-with graft- D7943

             

           ARTHROSCOPY OR ARTHROPLASTY: THAT IS THE QUESTION

 The CHCA was also asked to discuss nuances associated with CPT arthroscopy and arthroplasty codes.  While the two services require different resources, there is some gray area that this article attempts to clarify.  An arthroscopy is the use of an arthroscope to diagnose an injury or disease of a joint to perform minor surgery on a joint.  An arthroplasty on the other hand can be described as the surgical repair of a joint or the fashioning of a moveable joint using the patient's own tissue or an artificial replacement.

An arthroplasty code may be used only when the surgery is performed without the use of an arthroscope. Suitable OMS CPT arthroplasty codes include: 21240 (Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft)), 21242 (Arthroplasty, temporomandibular joint, with allograft and 21243 (Arthroplasty, temporomandibular joint, with prosthetic joint replacement).

An arthroscopy that is performed for the purpose of diagnosing an injury or disease of the TMJ is coded: 29800 (Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure)). An arthroscopy that is performed for the purpose of surgically treating the temporomandibular joint is coded: 29804 (Arthroscopy, temporomandibular joint, surgical). Neither the use of secondary portals nor the complexity of the arthroscopic procedure affect the procedure code.  Examples of procedures that are coded using the 29804 CPT code include: repair of the meniscus through the arthroscope, suturing of the disc via the arthroscope, and bone reduction via the arthroscope. There may be instances where a complicated arthroscopy could be reported with a modifier for increased difficulty. Documentation would need to accompany a claim to an insurance carrier to demonstrate the increased work and reason(s) making the increased work necessary. However, keep in mind that it is never appropriate to code an arthroscopic procedure using an arthroplasty code.