A broken tooth or a TMJ issue sounds like it would be a dental insurance issue, right? Not necessarily! Most medical insurance policies cover trauma/accidental injury to sound natural teeth (not due to a chewing or biting injury). Utilizing your patient’s medical benefits for trauma to teeth can help you save the patient’s dental benefits (which are typically very limited) for other dental in nature services needed throughout the year.

5 tips for Trauma to teeth or TMJ Medical Claims

1. Medical insurance policies specify that patients should seek care within 48 – 72 hours following an accident to the teeth or jaw

2. See the patient immediately -Time limits may be imposed by medical insurance policies. When an office verifies medical insurance, it is important to determine if treatment must be completed in 6 months, one year, 2 years or a similar time period (varies by insurer)

3. Radiographic images may be required when billing medical insurance for an accident case

4. ICD-10 codes are available for fractured or missing teeth along with an ICD-10 code that specifies the nature of an accident or incident. For example, S02.5XXB; Fracture of tooth from trauma

5. Call the medical insurer to perform a benefit verification to confirm details such as if the policy is active, and if a pre-authorization is required.

Sending the claim

A medical claim form, and clinical notes/SOAP notes from your evaluation of the patient, and from the ER/urgent care (if applicable). The medical claim form is the CMS1500, and the clinical/SOAP notes should be sent along with your medical claim to support the services. DentalWriter software is designed to help dental practices medically document their patient’s medically necessary services that are performed in the dental practice setting, in order to automatically generate their clinical/SOAP notes and completed medical claims.

Interested in learning more about cross-coding dental to medical billing? Nierman Practice Management has 30+ years of experience. Lead by cross-coding icon, Rose Nierman, our solutions for medical billing includes our live and virtual CE seminars, Nierman CE+, our new, online learning platform for dental-medical billing, and even a crosscoding hotline. To learn more about our solutions, explore our websites, or call 1.800.879.6468.

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