Building relationships in the medical community is paramount to a dental practice’s success in the Temporomandibular joint disorder (TMD) and Obstructive Sleep Apnea (OSA) realm. Dentist and physician collaboration is a necessity, not a nicety, for OSA. But even when working with a physician is not necessary for documentation or treatment purposes, dentists always benefit by working in tandem with physician colleagues for TMJ and sleep disorders patient care.
Let us start with TMD. Dentists can both diagnose & treat TMD without physician involvement. However, it is important to consider that creating mutually beneficial referral relationships can produce a steady flow of new patients that you may never have encountered otherwise. Practices commonly report receiving frequent referrals from health professionals in their area who do not treat TMD themselves (or wish to treat the condition from a collaborative approach), such as chiropractors, physical therapists, primary care physicians (PCPs), neurologists, physician assistants and nurse practitioners. From a medical reimbursement standpoint, while there is typically no requirement to obtain a prescription from a physician for a dentist to provide treatment for TMD, some policies such as Health Maintenance Organization (HMO) plans require a PCP referral before treatment.
On the other hand, oral appliances for OSA require more teamwork between the dentist and physician than TMD treatment. A partnership between physicians and dentists is critical, both from a clinical and a medical insurance reimbursement standpoint.
Reasons to collaborate with Physicians
- According to most state dental boards, it is not within the scope of dentistry to diagnose obstructive sleep apnea or interpret sleep studies. A board-certified sleep physician must perform the diagnosis.
- To be eligible for medical insurance coverage for a custom-made oral appliance to treat OSA, a patient must undergo an overnight sleep study and obtain a prescription or written order from a physician.
- Various medical insurers require physician involvement prior to oral sleep appliance therapy. For example, a physician may need to have a face-to-face visit with a patient before the sleep study before beginning treatment with an oral sleep appliance.
- Some medical insurers require that if a patient is intolerant to, refuses, or is contraindicated for Continuous Positive Airway Pressure (CPAP) therapy for OSA, the physician needs to be the provider to document the CPAP intolerance.
Dentists working with physicians for TMD and OSA diagnosis and treatment benefit all parties involved. Collaboration results in the best possible comprehensive care and creating healthy referral pathways facilitates robust treatment networks. Many physicians and dentists are working side-by-side for collaborative care and successful medical reimbursement for patients who need these life-changing services.
Please feel free to contact us with any questions related to this article on OSA and TMD. We host CE courses on Medical Billing for Dentists and clinical treatment of TMD disorders and Dental Sleep Medicine. For more information, contact Nierman Practice Management at 1-800-879-6468 option 1, by sending us an email at firstname.lastname@example.org, or by visiting niermanpm.com.
We have a variety of online and live courses for dentists, including topics such as dental sleep medicine, TMJ, craniofacial pain, and medical billing in dentistry. We also have a comprehensive, online course series for medical billing in dentistry.
Article by: Rose Nierman & Courtney Snow