Rose Nierman shows that when CBCT is needed for dental implants, knowing the proper medical billing codes is an effective way to encourage oral surgery case acceptance.
Rose Nierman says for patients and the practice it’s worth the effort to integrate medical billing
Did you know that it is possible to bill medical insurance for CBCT? Many dental practices bill medical insurance for sleep apnea appliances, oral surgeries, TMJ orthotics, and diagnostic imaging services.
Medical billing in a dental office is a necessity, not a nicety
Due to dental insurance’s newer edicts to send specific diagnostic and surgical claims to medical insurers first, a basic level of medical billing knowledge in a dental office is a necessity, not a nicety. When the patient has medical coverage, patients are eager to utilize the benefit, and rightfully so! The dental practice can benefit from medical billing for CBCT and bone grafting as charges for these procedures are commonly “left on the table” when dental coverage falls short. Medical billing can help to fill in gaps in coverage.
Dental to medical codes and policies for imaging
Cross-codes from dental to medical for a panorex (CPT 70355) and computerized bilateral tomography (CPT 76102) are available. Another common dental to medical cross code is CT Scan, Maxillofacial (CPT 70486).
To reimburse for imaging, the medical insurer needs to know what condition or symptoms are present. To process a claim, medical carriers will need an ICD-10 diagnosis code — for example, ICD K01.1, for impacted teeth.
According to medical policies, CBCT may be supported for presurgical planning when plain x-rays alone are insufficient. If a panorex or 2D image is needed, preauthorization is typically not required.
Dental practices encounter many conditions daily that potentially demonstrate that CBCT or other imaging is medically necessary.
Figure 1: Medical insurance sample policy for potential indications for imaging reimbursement
Some common indications for medical necessity
Partial or complete bony impactions, bony defects
Cysts, osteoitis, and jaw-related infections
Proposed implant placement near the inferior alveolar nerve or maxillary sinus
Proposed implant placement where there may be inadequate bone
Dental implants related to tooth loss from injury, trauma, or jaw pathology
TMJ disorder
The first step to integrate medical billing
At Nierman Practice Management (NPM), we are frequently asked, “What is the first step to getting started with medical billing?” According to Courtney Snow, teaching faculty at NPM’s Medical Billing in Dentistry Courses, “Once you examine the patient and have assigned codes, the first step is always to verify benefits with a patient’s medical plan. The great news is that you can find out in advance if a service is covered by the patient’s medical plan!” Many dental practices find that a little bit of help goes a long way in helping patients receive life-changing treatments, so it can be worth the effort. An area where NPM can help is by teaching offices not only the codes, but also the documentation needed for coverage.
With CBCT, dental implants, and obstructive sleep apnea being the fastest-growing areas in dentistry, dental practices need to have all the possible tools in their toolbox to help patients make decisions to move forward with recommended treatment.
Offering financing options and checking into medical benefits make it far easier for patients to accept treatment. These strategies used in conjunction with patient motivation are highly effective ways to increase oral surgery case acceptance.
Rose Nierman is a leading expert in cross-coding and medical billing in dentistry. For 30 years, Ms. Nierman has educated thousands of dental practices in medical billing and created the leading software system, DentalWriter™, which transforms specific questionnaire and exam data into medical necessity narrative reports and medical claims. Nierman Practice Management’s course CrossCoding: Medical Billing in Dentistry is available live or online. NPM’s Medical Billing Service streamlines medical reimbursement for dental practices. Contact Nierman Practice Management at [email protected], or call 1-800-879-6468.
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Each one-hour virtual webinar moderated by MedMark Media is equivalent to one continuing education (CE) credit. Credit is available to all who register for the webinar and successfully complete a ten-question quiz through our publication’s online system.
Registrants can attend the webinar live at the specified date and time by using the GoToWebinar join link provided by email from any device with an internet connection. Using a laptop or desktop computer is recommended for best viewing the presentation. If you are using a mobile phone or tablet, we recommend using the GoToWebinar app instead of the web browser to improve ease of use for the webinar’s platform. Registrants will also have access to watch the replay at their own convenience through a link emailed to them within 24 hours of the specified live date and time which is hosted on our publication’s website.
If registrants would like to ask a question or receive further clarification, they can type their questions or comments in the question box of the webinar system. The moderator reminds the attendees multiple times before and after the presentation to use the question box. Questions are addressed at the end of the presentation for at least ten minutes. If any questions come in that are not able to be answered live in the time available, we give the question along with the registrant’s email address to the presenter for them to follow up directly.
Registrants will have to either sign in (previous webinar attendee) or sign up (first-time webinar attendee) for our CE quiz system on our publication’s website. Registrants of all CE webinars are allowed this account free of charge. The ten-question quiz is linked on the replay page below the video as well as available directly through the CE dashboard once the registrant is logged in.
Once the quiz is successfully completed, there is a button to download a PDF of the certificate. A copy of the CE certificate is also emailed to the address on file for the CE account. To ensure the deliverability of emails about CE credits, please:
Check the spam/junk folder in your email account for the email.
If the registrant is having trouble accessing either the live webinar, replay, CE quiz or certificate we are available to help by email, chat, and phone. We can provide simple steps with screenshots on how to navigate to and complete the Webinar CE quizzes.
Legal disclaimer: Webinar expires 2 years from the live date. The CE provider uses reasonable care in selecting and providing accurate content. The CE provided, however, does not independently verify the content or materials. Any opinions expressed in the materials is those of the presenter and not the CE provider. The instructional materials are intended to supplement but are not a substitute for the knowledge, skills, expertise, and judgment of a trained healthcare professional.