Billing medical for cone beam computed tomography (CBCT)

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 has written another article about starting the journey toward medical billing in Implant Practice US. Read her article here: https://implantpracticeus.com/medical-billing-for-bone-grafts-oral-implants-and-cbct/

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 contactus@dentalwriter.com, or call 1-800-879-6468.

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