You’ve heard the adage of the three most important things in property: location, location, location. For TMD (temporomandibular disorder) medical claims, the adage is diagnosis, diagnosis, diagnosis! Whether you are treating an adolescent or an adult, documenting your clinical assessment using specific diagnostic codes is essential for record-keeping, for medical insurance reimbursement and retention of insurance payments. ICD-10 diagnostic codes are developed by the World Health Organization (WHO). The set of codes referred to as the International Classification of Diseases, Tenth Edition (ICD-10), is a clinical cataloging system modified in 2015 from the previous coding set to allow for more specificity. At the time of the 2015 ICD-10 release, codes for organ systems and body areas were designed to stipulate left and right sides of the body. Surprisingly, the TMD ICD codes were not as specific. Until now. On October 1, 2016, the majority of TMJ related ICD-10 codes were deleted and replaced with new codes which indicate left or right side or bilateral conditions.
The deleted codes and their replacements are listed below.
Deleted Temporomandibular Disorder (TMD) ICD-10 codes
- M26.60 Temporomandibular joint disorder, unspecified
- M26.61 Adhesions and ankylosis of temporomandibular joint
- M26.62 Arthralgia of temporomandibular joint
- M26.63 Articular disc disorder of temporomandibular joint
Added Temporomandibular Disorder (TMD) codes
- M26.601 Right temporomandibular joint disorder, unspecified
- M26.602 Left temporomandibular joint disorder, unspecified
- M26.603 Bilateral temporomandibular joint disorder, unspecified
- M26.609 Unspecified temporomandibular joint disorder, unspecified side
- M26.611 Adhesions and ankylosis of right temporomandibular joint
- M26.612 Adhesions and ankylosis of left temporomandibular joint
- M26.613 Adhesions and ankylosis of bilateral temporomandibular joint
- M26.619 Adhesions and ankylosis of temporomandibular joint, unspecified side
- M26.621 Arthralgia of right temporomandibular joint
- M26.622 Arthralgia of left temporomandibular joint
- M26.623 Arthralgia of bilateral temporomandibular joint
- M26.629 Arthralgia of temporomandibular joint, unspecified side
- M26.631 Articular disc disorder of right temporomandibular joint
- M26.632 Articular disc disorder of left temporomandibular joint
- M26.633 Articular disc disorder of bilateral temporomandibular joint
- M26.639 Articular disc disorder of temporomandibular joint, unspecified side
The ICD-10 codes are an essential part of your clinical record, and it’s important to include these TMD codes in your clinical notes as well as your letters of medical necessity. Also, when there is a secondary diagnosis, the sequence that codes are placed on a CMS 1500 medical claim form does matter. For example, a TMJ condition is typically coded first. Secondary codes, such as head pain (ICD R51) “tell the story” of medical necessity in that the TMJ disorder is primary and is causally related to head or cranio-mandibular pain.
TMD claims are processed favorably by many medical insurers when the dental practice knows the processes including documentation, narratives and billing codes that are appropriate. And with the new codes, it’s not only choosing the right diagnosis but the location that matters too!