Does medical insurance reimburse for oral appliances for obstructive sleep apnea or other airway issues in children? Medical insurers are beginning to consider oral appliances or functional orthopedic appliances medically necessary pediatric patients with airway issues. What do you need to send with a pediatric airway claim to medical insurance? The answer is a narrative report and a written plan that shows medical necessity.
An emerging trend is for medical policies is to review pediatric functional appliances as stated in a major medical policy: “Consideration will be given to oral appliances or functional orthopedic appliances in the treatment of children with craniofacial anomalies with signs and symptoms of obstructive sleep apnea (OSA).”
A pediatric airway claim will be reviewed so it’s essential to document symptoms such as snoring, mouth breathing, hyperactivity, daytime tiredness or bedwetting (which can be a symptom of an airway disorder in children).
DentalWriter Software Introduces a Pediatric Airway Module
Nierman Practice Management’s, DentalWriter™ Software generates a written plan showing medical necessity and if a custom oral appliance or a prefabricated device is being provided. The pediatric DentalWriter module also send claims to the patient’s medical insurance. Childhood major anomalies of jaw size, hypoplasia, microgenia or a vaulted palate are documented the narrative reports with the ICD-10 Diagnosis codes and CPT procedure codes easily located.
Implement Pediatric Airway Questionnaire and Exam Forms
With the unique pediatric symptoms of childhood airway disorders in mind, Nierman Practice Management (NPM) has created a dedicated pediatric questionnaire and exam forms to gather medical necessity documentation and generate narrative reports to medical insurance for review. This makes it easy to submit at pediatric airway claim.
Uncovering craniofacial anomalies and providing solutions for pediatric patients to improve airway function can change the lives for the better of pediatric patients with sleep breathing disorder or airway issues. To truly be successful, one must adopt dedicated pediatric airway forms and generate documentation of medical necessity. Once you have the history and exam data, you can get to the bottom of childhood sleep breathing disorders and make a difference.
Contact us today to learn more about OSA in children and how you can take the next step toward improving your knowledge and the services you offer in your dental practice. Send us an email at firstname.lastname@example.org or call 1-800-879-6468.
Author: Rose Nierman
Rose Nierman is a leading expert in cross-coding and medical billing in dentistry. Rose’s mission is to help dentists implement dental sleep medicine and TMD services. A major innovator in dental sleep medicine and medical billing software, DentalWriter, Rose developed Dental Sleep Medicine and TMD Questionnaire and Exam forms which are a standard to establish medical necessity. Nierman Practice Management provides Cross-Coding and medical billing seminars, live and online, along with Clinical DSM and TMD courses to dentists and their teams. To view our upcoming courses, visit niermanpm.com