
The Diabetic Patient and Medical Manifestations
December 20th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Treating a diabetic patient with medical oral complications may be covered under the patient's medical plan. With the patient's oral health at risk, the medical portion may reimburse for certain procedures, since medical plans only pay from medical necessity the treatment must be considered medically necessary. A diabetic patient is considered high risk and if the diabetes is marginally or poorly controlled may pose greater oral complications requiring medical intervention.
Some Oral manifestations that are generally seen may include some of the following:
- Gingivitis
- Periodontitis
- Disturbances of salivary secretion (Hypoptyalism, Ptyalism, Xerostomia)
- Burning sensation in the mouth (possibly be related to neuropathy)
- Impaired/delayed wound healing, increased incidence, and severity of infections
- Secondary infection with candidiasis
- Parotid salivary gland enlargement
With the above medical problems, you may consider billing the patients medical plan.
NOTE: Always check with the payer for coverage and exclusions for the patient's medical plan.
For example, if you were to bill the dental plan you would use the Dental Code, D4210 Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded spaces per quadrant.
When billing the medical plan you would use the following medical codes:
41872 Gingivoplasty each quadrant specify
K05.10 - Chronic gingivitis, plaque-induced
E11.630 - Type 2 diabetes mellitus with periodontal disease
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)
Reporting Modifiers 76 and 77 with ConfidenceApril 18th, 2023 - Aimee WilcoxModifiers are used to indicate that a procedure has been altered by a specific circumstance, so you can imagine how often modifiers are reported when billing medical services. There are modifiers that should only be applied to Evaluation and Management (E/M) service codes and modifiers used only with procedure codes. Modifiers 76 and 77 are used to identify times when either the same provider or a different provider repeated the same service on the same day and misapplication of these modifiers can result in claim denials.
Five Documentation Habits Providers Can Use Implement to Improve Evaluation & Management (E/M) ScoringApril 11th, 2023 - Aimee WilcoxProvider education on E/M coding updates is vital to the success of any organization, but how do you whittle down the massive information into bite-sized pieces the providers can learn in just a few minutes? Check out the five steps we have identified to teach providers in just a few minutes that can significantly impact and improve coding outcomes.
Second Quarter 2023 Updates are Different This YearApril 6th, 2023 - Wyn StaheliThe second quarter of 2023 is NOT business as usual so it is important to pay attention to ensure that organizational processes and training take place to avoid mistakes. Not only have ICD-10-CM coding updates been added to the usual code set updates (e.g., CPT, HCPCS, ICD-10-PCS), but the end of the COVID-19 Public Health Emergency will bring about changes that will also take place during the quarter (but not on April 1, 2023.
7 Measures Developed by the HHS Office of Inspector General (OIG) to Identify Potential Telehealth FraudMarch 28th, 2023 - Aimee WilcoxA recent review of telehealth services reported in Medicare claims data during the pandemic where these seven measures for identifying suspected fraud, waste, and abuse were applied, revealed more than a thousand Medicare providers potentially committed fraud during this period. What are the measures the OIG applied during their review, and how will that impact future telehealth guidelines moving forward?
MUEs and Bilateral IndicatorsMarch 23rd, 2023 - Chris WoolstenhulmeMUEs are used by Medicare to help reduce improper payments for Part B claims. This article will address the use of the National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) and how they are used by CMS.
It is True the COVID-19 PHE is ExpiringMarch 16th, 2023 - Raquel ShumwayThe COVID-19 PHE is Expiring, according to HHS. What is changing and what is staying the same? Make sure you understand how it will affect your practice and your patients.
Billing Process FlowchartMarch 2nd, 2023 - The Billing Process Flowchart (see Figure 1.1) helps outline the decision process for maintaining an effective billing process. This is only a suggested work plan and is used for demonstration purposes to illustrate areas which may need more attention in your practice’s policies and...