Medical Billing in Dentistry FAQ’s

Frequently Asked Questions

What documentation is required for claims to be paid by medical insurance?

A report or letter of medical necessity is very important to reimbursement. For sleep apnea appliance claims, there are other items of documentation that are important.

Is there a standard medical claim form?

The medical claim form is referred to as CMS-1500. DentalWriter™ software provides both PRINTING and/or ELECTRONIC billing of claims.

What are ICD Medical Diagnosis Codes?

ICD stands for International Classification of Disease. These codes are developed by the World Health Organization (WHO) to track and report diseases. To file a medical claim, the claim form must have atleast one ICD code.

What are CPT Medical Procedure codes?

CPT stands for Current Procedural Terminology. The CPT codes are published by the American Medical Association.

What are the most frequent services billed to Medical from a dental office using CPT codes?
Services such as exams, sleep apnea devices, TMD orthodics, bone graft relating to implants, abscess removal, and many other procedures are the most common CPT codes.
CPT codes are frequently used for radiographs such as Panorex, FMX, Cephalometric, CT scans and others.
CrossCode™ software and the new CrossCode™ App for your mobile device lets you find the corresponing medical codes. You can also see over 80 claim examples for medical billing with these products.
Medical Insurance frequently reimburses for accidental injury to teeth. Which situation would commonly be covered?
Most medical policies will pay for services needed due to accidental trauma to natural teeth. There are ICD diagnosis codes for broken and fractured teeth and the dental office can use an additional diagnosis code in the “E” code category to describe the accident. Such as E886.0; FALL ON SAME LEVEL IN SPORTS. Some examples are:
  • A broken tooth due to a fall whyle playing soccer
  • Missing teeth due to a fall from a ladder
  • A fractured tooth due to a slip and fall on a sidewalk
  • Many other types of accidents
We would like to help our patients with medical insurance reimbursement. What is the first step?
The first step in helping a patient assess if treatment is a medical necessity is asking the right questions of the patient. Nierman Practice Management has developed questionnaires to ask the important questions. Some answers which relate to the patient’s health may lead to discovering that the treatment is medically necessity.
If a patient cannot eat, swallow, breathe and function properly, those problems or complaints may correspond with a medical diagnosis code. Policies can be verified for coverage.
Do you see medical insurance reimbursing for services for patients who have periodontal disease and systemic disorders?
The first step in helping a patient assess if treatment is a medical necessity is asking the right questions of the patient. Nierman Practice Management has developed questionnaires to ask the important questions. Some answers which relate to the patient’s health may lead to discovering that the treatment is medically necessity.
If a patient cannot eat, swallow, breathe and function properly, those problems or complaints may correspond with a medical diagnosis code. Policies can be verified for coverage.
Some dental insurance plans now reimburse for additional hygiene visits when there is periodontal disease and systemic disease. How do I find out about these?

When the patient has both dental and medical insurance with the same insurance plan, the dental insurance portion will often provide these services as part of a systemic health integration plan. Some medical insurers will step up to the plate for diagnostic testing for oral infections or medicaments. Where these benefits would be paid can be verified with the insurance carrier.