Will medical insurance coding and billing for dentists help your patients by paying for oral cancer screenings? Medical billing is something dental offices may want to consider, especially when the patient lacks dental insurance and for screening tools. Although it may seem obvious that oral cancer screenings are covered by insurance, most dental plans do not cover a screening outside of the exam (even though there is a separate code for it). The ADA considers oral cancer screenings inclusive in the dental exam codes.
The Mouth is Connected to the Body
That’s where medical insurance comes into play! Oral cancer is, after all, a medical condition when it comes to treating it. Increasingly more medical insurance companies are reimbursing for screening procedures in all areas of the body, and the mouth is connected to the body. Dental practices and insurance companies know the importance of regular oral cancer screening, even when the patient does not have risk factors such as tobacco use, excessive use of alcohol or family history.
In fact, over 25% of all oral cancers occur in nonsmokers and people who drink alcohol only occasionally. The Oral Cancer Foundation says that close to 50,000 Americans will be diagnosed with oral cancer this year. When oral cancer is found early and treated, before it has time to spread to other areas of the body, the survival rate nearly doubles.
Medical insurance companies know that covering screenings may save them money in the long run. When you show that those services are clinically necessary and a potential life-saving measure, the insurance company can see, “Gee, this screening is $40, while treatment for oral cancers may exceed $40,000.”
Make the Case
The best way to get medical insurers to cover services in the dental office is by making a case that your treatment is medically necessary. Start with appropriate medical coding; International Classification of Diseases (ICD) for diagnosis. Your services are then billed with Current Procedural Terminology (CPT), compiled by the American Medical Association. A medical coding scenario includes codes such as; Encounter for screening for malignant neoplasm of the oral cavity. Other related procedures with medical codes are for biopsies and removal of lesions. Additionally, Cone-beam Computed Tomography (CBCT) is often billed to medical insurance, when considered necessary.
Speak the Language in Medical Billing for Dentists
“You need to speak the insurance company’s language. Medical carriers will often offer coverage for services if they’re proven to be efficacious, and are necessary for the patient to function as normal as possible,” says Courtney Snow, the Director of Medical Coding and Billing training for dentists at Nierman Practice Management. “They want to see the reason. If you can show how the services would return the patient to normal, necessary function, they will often step up to the plate.”
Author: Rose Nierman, Founder & CEO, Nierman Practice Management