Dental - Articles

Staging and Grading Periodontitis
October 12th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
We now understand periodontitis may present itself as a manifestation of systemic diseases in fact; according to DeltaDental, research shows that more than 90 percent of all systemic diseases have oral manifestations, including swollen gums, mouth ulcers, dry mouth, and excessive gum problems. Some of these diseases include: Diabetes Leukemia Oral cancer Pancreatic cancer Heart ...
Dental-Provider Specialty Taxonomy Codes
October 6th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
The National Uniform Billing Guidelines require the use of taxonomy codes for claims submissions on the ADA-Dental claim form and the CMS-1500 Medical Claim form. When reporting the taxonomy code, be sure the provider is contracted with the payer under the taxonomy code being reported. We have listed the general ...
Billing Dental Implants under Medical Coverage
August 12th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.    Implants could be considered ...
Compliance in the Dental Office or Small Practice
June 29th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
If your practice does not already have a compliance program in place, you will want to get started after reading this article. We have uncovered some important findings with the Office of Inspector General (OIG) in dental practices you need to be aware of. A compliance program offers standard procedures to follow, ...

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CDT and CPT - The Same but Different!
December 8th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Reporting a CPT code for an evaluation of a patient is based on time and if the patient is a new or established patient. Evaluation and Management codes are different than other codes, it is important to understand how they are used, prior to 2021 they were based on a ...
Important Podcast on Dental to Medical Billing
September 21st, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Be sure and check out this discussion with LaMont Leavitt (CEO of innoviHealth) and Christine Taxin (Adjunct professor at New York University, President of Dental Medical Billing, and Links2Success).  Some of the resources and tools they discuss will help you with your dental coding/billing and education. Do You Have All the Right ...
Podcast - Do you have all the right Dental resources needed to succeed in Dental Medical Billing and Coding?
August 27th, 2020 - Innoventrum
Discussion between innoviHealth CEO, LaMont Leavitt and Guest speaker, Christine Taxin who is an Adjunct professor at New York University, and President of Dental Medical Billing and Links2Success about making sure you have all the right Dental resources needed to succeed in Dental Medical Billing and Coding. ...
New and Exciting Changes in the Dental Industry
August 26th, 2020 - Christine Taxin - Links 2 Success
My colleagues and I are nerds for information on all things billable—or not billable—in the worlds of dental and medical insurance. One of the most puzzling challenges for me over the past 15 years of teaching has been to understand why we on the dental side are segregated out of ...
Modifier 50 — Four "Must Know" Tips For Getting Paid
August 10th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional...
Are NCCI Edits Just for Medicare?
July 14th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...
Should I Bill Dental or Medical?
June 16th, 2020 - Christine Taxin
While you likely find yourself focusing on fewer patients and more on emergency care, it’s a good time to understand how medical billing can allow patients with active infection in the oral cavity to seek the treatment they need. Forms need to be filled out correctly, and you must carefully follow ...
Medical Necessity using Soap can prevent a future audit!
June 15th, 2020 - Christine Taxin
Medical Necessity using Soap can prevent a future audit! How Do I Correctly Document all my notes on every patient regardless of the insurance I am billing? Medically necessary care is the reasonable and essential diagnostic, preventive, and treatment services (including supplies, appliances, and devices) and follow-up care as determined by qualified ...
Changes in Medicare Advantage and Part D
June 2nd, 2020 - Christine Taxin
The Centers for Medicare & Medicaid Services finalized several changes in Medicare Advantage and Part D on Friday. The Trump administration has finalized several changes in Medicare Advantage (MA) and Part D in anticipation of bid submissions on June 1. The Centers for Medicare & Medicaid Services (CMS) released Friday that includes ...
ADA is Asking for HELP with Third-Party Payers for Dentists
April 14th, 2020 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
With these unprecedented and extraordinary circumstances, dentists are facing new challenges with reimbursement with what is allowed and covered under their contractual obligations with their payers. The ADA recognizes the struggles dental providers are facing and is urging third-party payers to adopt new reimbursement procedures and adjust their fee schedules to help ...
Documentation Skills that Increase Your Coding
February 18th, 2020 - Christine Taxin
Evidence-based medicine such as the updated periodontal staging and caries lesions also gives well-defined information about the clinical condition itself. You cannot just look at the codes, you need to check the policy. When I am coding or teaching coding, you need to use clinical indications when working with documentation ...
Documenting telephone calls at your dental practice is just as important as documenting patient visits.
February 4th, 2020 - Christine Taxin
Documenting telephone calls at your dental practice is just as important as documenting patient visits. Similar to other documentation, the common rule when it comes to call documentation is that if it is not documented, it did not happen. Therefore, every clinically relevant telephone call should be documented. Clinically relevant calls ...
Non-Surgical Periodontal Treatment
January 14th, 2020 - Christine Taxin
AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment.Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.SCALING AND ROOT PLANINGScaling ...
American Dental Association (ADA) and Delta Dental Plans Association (DDPA) Class Action Lawsuit
December 10th, 2019 - Christine Taxin
The American Dental Association and two individual dentists filed a class-action lawsuit Nov. 26 against the Delta Dental Plans Association, its affiliated national entities, and 39 independent Delta Dental companies, alleging the provider network has engaged in anticompetitive conduct and violated federal antitrust laws. The complaint alleges Delta Dental allocated territories ...
Regence: Dental Procedures Under The BlueCard Program?
December 9th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
This information can be found on Regence/Blue Cross Dental procedures explaining additional benefits for dental procedures. Regence currently does not offer dental benefits, however, there are times a patient can receive treatment with a Blue Cross provider and qualify under their medical benefits. In addition, Regence informs the providers to file these claims ...
Medical Insurance Coverage for TMJ Disorders (TMD)
November 19th, 2019 - Christine Taxin
It is agreed that TMJ disorders should be covered by insurance. There are often questions whether it is covered by medical insurance or dental insurance and where the line is that separates coverage.Medical Insurance typically is the primary insurance for TMJ disorders. The reason is that joints are found anywhere ...
Documentation Tips
November 18th, 2019 - Christine Taxin
Documenting Medical NecessityTo receive reimbursement from medical insurers, you need to make a case that proves that dental surgery is necessary for the patient. To make your case, you need to explain your decision process in terms that a medical insurer can understand, using ICD-10 codes and CPT codes. These ...
Are you providing TMD treatment and having a hard time receiving payment from Medical? Take a look at the law for your state!
November 3rd, 2019 - Christine Taxin
TM TREATMENT AND THIRD PARTY INSURANCE COVERAGEMinnesota, in 1987, became the first state to adopt legislation requiring health insurance policies issued within the state to include coverage for the diagnosis and treatment of temporomandibular (TMD) joint disorders and craniomandibular (CMD) disorders on the same basis as other joint disorders. At ...
Wellness In the Dental Practice
September 25th, 2019 - Christine Taxin
This course is the beginning of change. Understanding that patients have additional benefits under their dental plans will provide you with the changes taking place in the world of billing. Objectives PROFESSIONAL GROWTH Professionally your team members will be pushed and stretched as you develop your new system. They will require advanced training ...
Help is on the way!
September 17th, 2019 - Christine Taxin
Dental carriers are starting to deny coverage for treatment considered a medical necessity! Dental offices are just charging the patient for those services or patients are refusing the treatment. Have you considered why that service should be full fee for the patient when they have coverage under their medical insurance? ...
A Step by Step Guide to Medical Billing
August 20th, 2019 - Christine Taxin
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 ...
Medical ID Theft
August 16th, 2019 - Namas
Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...
Healthcare Common Procedure Coding System (HCPCS)
August 13th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...
Tips to Preventing Audits
July 23rd, 2019 - Christine Taxin
There is an ever-increasing number of dental claims that have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and billing practices. When payers identify the activities they deem ...
Are you Treating & Billing Medical Patients Tooth Infections
July 16th, 2019 - Christine Taxin
A tooth infection, or an abscessed tooth, generally occurs as a result of tooth decay and poor oral hygiene. However, it can also develop due to previous dental work or traumatic injury. When an infection occurs, it causes a pocket of pus to form in the mouth as a result ...
5 Ways to Minimize HIPAA Liabilities
July 12th, 2019 - BC Advantage
Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...
The Oral Connection
June 24th, 2019 - Christine Taxin
The mouth is, was, and forever will be part of the body. The old model in traditional medicine of treating symptoms and body parts in isolation is flawed. Pioneers in functional medicine like Dr. Mark Hyman, Dr. Mike Roisen, Dr. Axe, Dr. Fuhrman, Dr. Amy Doneen, Dr. Brad Bale, and ...
Do You Understand Medicare
May 21st, 2019 - Christine Taxin
Even though we may think we truly understand what it means to be a participating provider, Medicare doesn’t quite work the way that other insurance plans do. Far too many providers do not understand the difference and get into hot water. To further complicate matters, the rules are different for ...
Looking Ahead - Changes in Dentistry!
April 3rd, 2019 - Christine Taxin
In the next 10 years, what is the biggest change dentistry will experience? FW: We all know healthcare in the U.S. is changing rapidly. Dentistry is no exception. My opinion is that several big changes are forthcoming. Most often, I think about changes that benefit patients and/or providers. Here are three ...
Consent for CT Scan - Women
February 19th, 2019 - Christine Taxin
The ADA has forms in over 26 lanuages available to purchase. You also need specific forms for all of the procedures. Even working with patients who are pregnant needs to have a consent with a specialty and collaboration with medical providers. I am showing you one of the forms...
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...
Preventive Medicine: Dental Caries in Children
May 9th, 2018 - Find-A-Code
Preventive Medicine Topics Page Dental Caries in Children Procedure Codes 99188: Application of topical fluoride varnish by a physician or other qualified health care professional ICD-10-CM 99188: No specific diagnoses Frequency 99188: No specific frequency guidelines Additional Information 99188 Covered for children from birth until their seventh birthday Find-A-Code™ - Preventive Services - The information ...
Medical to Dental Billing, Truth or Dare?
April 30th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Is it true that medical benefits are only accessible by physicians? This is NOT True! Perhaps you have been told it is illegal for a dentist to bill a patient’s medical insurance, this is erroneous information. In fact, the Accountable Care Organization’s objective is to provide better management of care ...
Proper Record Keeping and Documentation
April 19th, 2018 - Christine Taxin
Proper record keeping and documentation is not only essential for today’s dental practitioner, but is also required by law. Moreover, correct, current and accurate records directly enhance patient care by enabling the dentist to plan treatments, monitor progress, and provide essential notations. Clear and concise treatment plans, medical alerts, and ...
Reporting Tooth Numbers and Oral Cavity Areas
February 1st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
When billing for dental procedures you need to identify the exact tooth and/or location in the oral cavity. Qualifiers are used to report the location and tooth number. When billing procedures on teeth and the oral cavity, the JP qualifier is used to identify the tooth number(s) and the JO ...
Dental and Medical- Controlled Substance Awareness
January 29th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
As an effort to cut down on opioid abuse and related crimes, in August of 2017 the Attorney General Sessions established a new Department of Justice (DOJ) section called “Opioid Fraud and Abuse Detection Unit”. Due to the serious public health issue and drug overdose deaths, this unit was established and ...
Dental Providers- So what are ICD 10 codes?
September 11th, 2017 - Christine Taxin
What has been your definition so far when asked about how they are different? What does an ICD-10 code look like? How does an ICD-10 code work? Have you seen commercials about medical coding schools and wonder if the profession is right for you? With the field expected to grow faster ...
The First Phone Call to Your Office
August 17th, 2017 - Chris Woolstenhulme, CPC, CMRS
The telephone has a huge impact on your practice. The very first phone call to your office will be the beginning of the patient relationship to the practice, and if not handled correctly may potentially be the last. https://www.dentalcare.com/en-us/practice-management/scripting/use-a-telephone-script-scripting-conversations Chose your words carefully. https://www.dentalcare.com/en-us/practice-management/scripting/raise-the-energy-level-with-a-power-words-list Welcome: https://www.dentalcare.com/en-us/practice-management/scripting/dental-scripts-scripting-the-patient-welcome Scheduling. It shapes everyone’s day and has a direct ...
Transparency and Fees
August 15th, 2017 - Christine Taxin
More than any other industry, healthcare is almost notorious for its lack of price transparency. While patients generally know how much their copay will be and certainly how much their final bill turns out to be, few hospitals and practices publish the actual costs of their services prior to those ...
Do Other States Lower Payments for Crowns by Delta or Blue Cross?
August 11th, 2017 - Christine Taxin
Question: A subscribers from the State of Michigan has asked this: Has anyone from other states seen the fees for crowns lowered by Delta or Blue Cross? Answer: First look at your contracts, and see if there is anything in it that allows for fees to be lowered. Next, look up your ...
Compliance Program - What are the Requirements to Implement an Effective Program?
August 1st, 2017 - Christine Taxin
All sponsors are required to adopt and implement an effective compliance program, which must include measures to prevent, detect, and correct Part C or D program non-compliance as well as FWA. The compliance program must, at a minimum, include the following core requirements: 1. Written Policies, Procedures, and Standards of Conduct; 2. Compliance Officer, Compliance Committee, ...
Sleep Testing
July 26th, 2017 - Chris Woolstenhulme, CPC, CMRS
Once a patient has been evaluated for symptoms associated with sleep apnea, testing is ordered to identify severity and determine treatment. There are several types of sleep tests, but coverage is based on meeting the criteria for Type I (inpatient facility based) or Type II-IV and Other (home-based sleep tests). All ...
Deadline
April 28th, 2017 - Christine Taxin
Prescribers, including dentists, who write prescriptions for Part D drugs are to be enrolled in an approved status or validly opted out with Medicare, in order for their patients’ prescriptions to be covered under Medicare Part D. Full enforcement of Part D prescriber enrollment requirement will begin on January 1, 2019. ...
Treating TMJ
April 4th, 2017 - Chris Woolstenhulme, CPC, CMRS
Temporomandibular Joint (TMJ) Syndrome can include a wide variety of conditions that may be characterized as TMJ. Also there are a wide variety of methods for treating these conditions. Many of the procedures are excluded from coverage in the Medicare program for services or devices. There are other services and appliances ...
Moderate Sedation Services - CPT has 6 Codes to One Dental Code
March 30th, 2017 - Chris Woolstenhulme, CPC, CMRS
When billing a medical code instead of the dental code D9223 -Deep sedation/general anesthesia - each 15 minute increment, consider the following medical codes: (Be sure to review the AMA guidelines to see if they fit the procedure you are doing). If a dental office is doing conscious sedation for a patient ...
Devices Used for Treatment with TMJ
March 27th, 2017 - Chris Woolstenhulme, CPC, CMRS
Dynamic splinting systems or devices are used to assist in restoring physical function and are commonly used for treating TMJ. Injury or joint stiffness are diagnoses that may qualify for medically necessity. If physical therapy has proven ineffective to restore or improve range of motion, mechanical devices are often a next step. This ...
Taxonomy Code Information
March 13th, 2017 - Chris Woolstenhulme, CPC, CMRS
Taxonomy Codes are used to define a Healthcare Provider type as well as the classification and area of specialization. These codes are reported on the ADA form and on the CMS-1500 Medical claim form. For a complete list of all classifications, visit FindACode.com 122300000X - DentistStatus: ActiveDefinition: A dentist is a person qualified by a ...
Reporting Unilateral Procedures
March 13th, 2017 - Chris Woolstenhulme, CPC, CMRS
Some procedures are unilateral such as D7840-Condylectomy. It is important to consult with your payer on reporting requirements. Some payers require two separate line items with a LT or RT HCPCS Modifier, while others require only one modifier to be appended to the claim. When billing a medical code for a Condylectomy, ...
A Must Have for Every Dental Office!
February 1st, 2017 - Chris Woolstenhulme, CPC, CMRS
Don’t let managed dental plans sneak up on you! Announcing InstaCode's 2017 Reimbursement Guide for Dental with Medical crosswalks. We are excited to introduce a truly unique product that will be even more beneficial to the financial health of your practice. Some of the new features include: CDT, CPT, ICD-10-CM and HCPCS CDT to CPT ...
Oral Maxillofacial Prosthesis (A53496)
December 6th, 2016 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Implants, which could be considered dental but are being inserted to secure, attach, or support the maxillofacial prosthesis, will be covered when the prosthesis is to be used secondary to maxillofacial surgery or repair of traumatic injury. Use CPT code 21299 to bill the implants with an explanation of the intended use. ...
Dental Examination Prior to Kidney Transplantation
December 6th, 2016 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Despite the "dental services exclusion" in §1862(a)(12) of the Act (see the Medicare Benefit Policy Manual, Chapter 16, "General Exclusions from Coverage," §140), an oral or dental examination performed on an inpatient basis as part of a comprehensive workup prior to renal transplant surgery is a covered service. This is because ...
Billing for Prosthesis Designed and Prepared by the Dentist
December 6th, 2016 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
For maxillofacial services, if a prosthesis is provided, and is designed and prepared by the dentist, the Medicare Part B carrier may be billed with CPT codes 21076 through 21089. If the prosthesis is prepared by an outside laboratory, the laboratory bill goes to the Durable Medical Equipment Regional Carrier (DMERC), with Level ...
Changes in Dental codes for 2017
September 27th, 2016 - Christine Taxin
Below is a list of changes in Dental Codes for 2017, please do not use these codes until January of 2017.  Also, understand how to use and remember document, document why you are using any code.DIAGNOSTIC D0120-D0999REVISIONS:NO CHANGESNEW CODE:D0414 Laboratory Processing of microbial specimen to include culture and sensitivity studies, ...
Dental Offices - Billing Medical Insurance for covered procedures
September 12th, 2016 - Christine Taxin
If your dental office isn’t billing medical insurance for certain procedures, you’re missing out on an important way of serving your patients and expanding your practice. Currently, only about 64% of Americans are covered by a dental insurance plan. But the Affordable Care Act requires nearly 100% of Americans to be covered ...

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