Many dental practices bill medical insurance for medically necessary procedures such as Oral Appliances for Obstructive Sleep Apnea, TMJ splints and oral surgeries such as bone grafts, wisdom teeth extractions, and dental implants.
A great way to distinguish your dental practice is by letting your patients know that your office bills medical insurance for certain services.
An example of medical coding is the International Classification of Diseases (ICD-10) Code, or Diagnosis Code K08.419, which specifies Loss of Teeth, Due to Trauma.
Y93.66 is another Diagnosis Code, specifying Injury During Activity Involving Soccer.
Combining both codes on a medical claim form, this coding scenario shows that there was a Knocked-Out Tooth during Activities Involving Soccer.
There seems to be a code for just about everything that can happen to a patient during the course of a day. For instance, there’s even a code for Injury During Vacuuming, which this author considers to be a potentially dangerous activity to be avoided. All humor aside, Dental Medical Billing unquestionably helps insured Americans maximize health insurance benefits when coverage is available.
Three Ways that Dental Medical Billing Benefits a Dental Practice:
1. Receive higher case acceptance. With the help of medical insurance, many patients can move forward with needed treatments.
2. Save dental insurance benefits for tooth related procedures. Since most dental insurance plans are more like a “coupon” program than actual insurance, dental insurance plans do not reimburse what most consumers expect or wish to see. On the other hand, health insurance plans are there to protect the consumer from high medical costs and provide higher reimbursements. By utilizing medical insurance for allowable treatments, patients can save dental benefits for routine dental procedures.
3. Distinguish your dental practice by adding unique services to your practice:
Obstructive Sleep Apnea Oral Appliance Therapy: Research shows that 18-25 million Americans (1 in every 15) are living with the dangerous condition of obstructive sleep apnea which can be managed by oral appliance therapy while sleeping (for mild or moderate sleep apnea). Treating Obstructive Sleep Apnea with Oral Appliances is a field called Dental Sleep Medicine and helps to save lives and relationships. Most medical insurance policies do provide reimbursement for oral appliances for CPAP intolerant patients, and dental sleep medical billing is pretty straightforward and easy to implement. Oral appliance therapy sets your practice apart as part of a multidisciplinary team with other caregivers and physicians.
TMJ splints offer another potential area for practice growth and are considered “medically necessary” by many insurance companies. Approximately 40 states have passed specific laws that mandate health insurance coverage for TMJ treatment. When these services are covered, dental records such an exam, CT scan or panorex are also covered. Be a hero to your patients by solving the puzzle to their headaches and TMJ pain and then go that extra mile by billing their medical insurance.
Oral Surgeries Many dentists are adding more complex surgical procedures to their practice and find that medical insurers do frequently pay for oral surgery. Currently, many dental plans ask that dental practice bill medical plans for oral surgery before billing dental, so knowledge of medical billing has become a must for dental practices. In fact, the question shouldn’t be IF you should add medical billing to your practice, but HOW.
So, what does it take to bill medical? With the release of ICD-10 diagnosis codes in 2015, there is a code for every situation or condition that comes your way and Current Procedural Terminology (CPT) codes for exams, dental radiographs such as a panorex or cone beam, oral appliances and surgeries. The codes in conjunction with the medical claim form and the right narrative reports of medical necessity make it easier than ever to take your practice to a new level of success and grow the many unique services that are covered by medical insurance.
To get started, CrossCode™ Software is an online program that codes from Dental to Medical with over 80 dental medical claim examples at your fingertips. A CrossCoding Manual and Narrative Report and Dental Medical Billing Software is also available through Nierman Practice Management (NPM). Another great option is NPM’s Continuing Education seminar, CrossCoding; Unlocking the Code to Medical Billing in Dentistry, offered in several locations around the U.S.