A Step by Step Guide to Medical Billing

August 20th, 2019 - Christine Taxin

Categories: Dental Oral and Maxillofacial Surgery

The next 4 weeks we will be providing you with a step by step guide to why medical billing is now part of our Dental future.

Dental surgery is performed to treat various conditions of the teeth, jaws, and gums. Surgical procedures that dentists perform include dental implants, treatment for temporomandibular joint (TMJ) disorder, wisdom teeth removal, facial trauma, corrective jaw surgery, and periodontal surgery to treat gum conditions such as gingivitis or periodontitis. Billing medical insurance for dental surgery that is medically necessary can help patients maximize health insurance benefits. Today, many dental offices are relying on dental billing services to ease this task. In fact, with declining reimbursement rates, practices need to make the most of both the patient’s medical and dental insurance to receive maximum reimbursement for dental surgery. Here are some important things dentists need to know about medical billing for dental surgery:

1. Understanding the need to understand what is medical necessity and WHY!

Establish medical necessity:

One of the tools my students use is PreViser. It will show a risk assessment score that shows the patient and the medical team Low, Moderate, or High risk. Medical insurance plans will reimburse procedures that dentists perform, provided they are medically necessary and properly coded as medical procedures. Medically necessary treatment is that which is provided when the patient is medically compromised by a problem that the dentist treats. For example, medically necessary tooth removal, the removal of impacted teeth, and the removal of teeth before radiation therapy or an organ transplant can be billed to medical insurance. Medical plans also cover soft and hard tissue biopsies and extractions and the surgical placement of dental implants. A Dental Practice Management article points out that for success with medical billing claims, dental practices need use the correct ICD-10 codes and CPT codes to document all aspects of the care provided. Go to www.dentalmedicalbilling.com and look under resources to download PreViser.

P.S. you can code that for billing dental.

Then make sure you collect the following information:

The chief presenting problem
Any secondary, supporting diagnosis
The diagnostic code for the treatment planned
Surgical pre-authorization
A letter of medical necessity outlining the case for surgery
Supporting letter of medical necessity from the patient’s Primary Care Physician
The procedures performed at each surgery location

The documentation should inform the payer that the patient’s concern was a medical one and not just a dental problem. For instance, in the case of implants, the documentation should explain two things: the reason for the tooth loss and why the tooth needs to be replaced. All contributing factors from the patient’s medical history can be stated in the Letter of Medical Necessity.

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