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Tips On Dental Coding. Some Coding Facts There are 500 procedures in Dental 90 procedures on average are done in the dental office. If you are a “referadontist”

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Presentation on theme: "Tips On Dental Coding. Some Coding Facts There are 500 procedures in Dental 90 procedures on average are done in the dental office. If you are a “referadontist”"— Presentation transcript:

1 Tips On Dental Coding

2 Some Coding Facts There are 500 procedures in Dental 90 procedures on average are done in the dental office. If you are a “referadontist” – meaning you send out a lot of procedures then you only use 60 procedures not the 90 average.

3 Clean up your coding! Delete or inactivate the deleted codes Enter only the new codes that specifically apply to your practice. Delete inactive codes

4 Did you know there’s a new code for sectioning a failed bridge in which the good retainer is left indefinitely in the mouth? D9120 An Extraction (D7140) of the failed retainer with pontic should be reported in addition to D9120

5 Extra Lab Procedures w/Partial D2971 this is an extra lab procedure required to make the new crown fit the existing partial denture Did you miss this code? The lab usually charges you $50-$70 extra. Bill crown (regular fee) plus D2971 (typical fee $150) on the seat date.

6 Are you coding out Core Buildups (D2950) separately & raising the crown fee (which leaves money on the table). The PPO’s limit the crown fee and the buildup could have been paid with proper documentation and narrative! The average DDS reports various types of buildups on 43% of the crowns & crown retainers.

7 Fluorides Effective 1/1/13 use D1206 for Fluoride Varnish applications, regardless of caries risk. D1208 is for any Fluoride other than varnish like Fluoride trays etc…

8 Effective 1/1/13 D1203 & D1204 are deleted – your only choices are D1206 & D1208. Fluoride varnish should be used as the type of fluoride for all patients ! Most effective is D1206

9 Are you not reporting the Comprehensive Periodontal Evaluation for new patients at all? D0180 D0180 typically reimburses better than D0150 & has a higher UCR allowance. However, to report D0180 the patient must be either a perio patient (4-5mm pocket depths, BOP, and some bone loss) OR Have risk factors for periodontal disease such as diabetes, smoking or heart disease. In addition, a full mouth probing & charting is mandatory to report D0180

10 Do you have high emergency evaluation (D0140) counts while your pallative (D9110) counts are low? While D0140 can always be reported at an ER visit, it remains subject to the “two evaluations a year” rule. If D0140 is reported in conjunction with definitive treatment (such as fillings, extractions, rc, etc.), often D0140 is NOT reimbursed. However, if the doctor only uses one evaluation a year (checking recall once and not twice) then a second ER evaluation would probably be paid. The general objective is for the D0140 counts to be lower while pallative (D9110) counts should be higher. Generally pallative (D9110) has a higher UCR than D0140.

11 Pallative – D9110 At emergency visit Minor procedures only Smooth sharp corner of tooth Adjust occlusion for pain relief Remove decay, IRM placed Desensitize tooth Open tooth – partial debridement Lance abscess for pain relief Partial heavy calculus debridement (only with patient complaint of discomfort) Apthous ulcer relief

12 Pallative – continued One of the least reported codes Typically allowed up to 2 times per year Cannot report any other treatment on same visit date with most plans Xrays are OK Always use the narrative Auto rejection of this code if you do not provide a narrative.

13 Do you take single BWX’s at a ER visit? This will use up your annual 4 BWX coverage Look at your single film counts – the count should be close to zero. Instead, consider two PA’s at the ER visit, which are almost always clinically justified and paid!

14 The Coronal Remnant Code D7111 mistake This is NOT for routine baby tooth extraction It is only for the coronal remnant (piece of the shell of the crown) D7140 is reported when the primary tooth has a full crown & any root remains. UCR is higher for D7140 than D7111 Many times it is miscoded as D7111

15 New Code D2929 This is a new code for Primary Tooth Pre- Fabricated Crown Must be a ceramic crown only!

16 New Code D2990 This is for the Icon Resin Infiltrant This is a product used for incipient caries and white spot lesions. It is microinvasive technology that fills, reinforces and stabilizes demineralized enamel without drilling or sacrifacing health tooth structure. Excellent product by DMG America

17 Onlays Onlays can be reimbursed with excellent documentation (photos, xrays, need for a crown etc…) To be considered an onlay the cusp(s) must be “capped” or “shoed”. An onlay always involves the facial and/or lingual surfaces. MOF, MOL, MODFL – all okay

18 Are you reporting 2BWX when 4BWX should be reported when 2 nd molars have erupted? If so, lots of money is left on the table! If you have a higher count for 2BWX than 4BWX in your adult practice then money is left on the table!

19 Do you rarely code a surgical extraction (D7210) for an erupted tooth & use (D7140) for all extractions? The UCR of D7210 pays 50% to 100% more than D7140. D7210 should document that bone was removed or the tooth was sectioned. A flap is not required but optional starting 1/11/11.

20 Is one recall evaluation (D0120) reported annually when two are generally payable? Most policies pay either 2 evaluations a year 1 evaluation per six months, so reimbursement is available! However, if the doctor is checking multiple hygienists and only wants to check recall patients once a year, then once a year is OK.

21 Do you use two surface fillings (D2331) for the incisal edge of an anterior tooth when it is always four surfaces (D2335) – MIFL or DIFL? If you have a low procedure count of code D2355 it’s a tip off. For incisal edge of the tooth, the surfaces would be one, two, or three depending on the dentists preparation of the tooth.

22 Are you coding out a perio bone graft (D4263/D4264) (associated with osseous surgery and natural teeth)? The graft is actually a bone socket graft (D7953) done in conjunction with an extraction!

23 Lab Relines (D5750-D5761) versus Chairside Relines (D5730-D5741) You can use the lab reline (which pays more) instead of the chairside reline if a triad oven or pressurized water bath is used to process the denture in the dental office

24 Immediate Denture Info Do you know that the immediate denture (higher fee) is reported upfront and that later a reline/rebase is paid if the proper waiting period is observed? Can be up to 6 months after the extraction date, to the day. Do not include the reline/rebase fee in the immediate denture fee.

25 Standard denture versus implant supported denture Many offices report a standard denture when they are really doing an implant supported denture. The implant supported denture has a higher fee allowed, if controlled by a PPO plan. This generally results in a lower write-off!

26 Are you reporting standard denture when you are really doing an implant supported denture? The implant supported denture has a higher fee allowed, if controlled by a PPO plan. This generally results in lower write-off.

27 Are you charging for a standard crown when it is really an implant crown? This can be fraud, if done to get a better benefit. However, generally with PPO’s, a higher fee is allowed by charging out an implant crown, which is a better benefit.

28 Are you charging a high global fee for an implant crown? PPO’s knock down the fee substantially You should charge out separately for the abutment Either a prefab abutment (D6056) or Custom abutment (D6057)

29 Abutment-supported codes You probably are not aware that abutment- supported codes should be reported instead of implant supported codes if an abutment (D6056 or D6067) is involved. If an abutment is not involved, charge out the implant-supported codes, which are not generally done by most offices.

30 Occlusal Guard Info D9940 Occlusal Guards are paid about 35% of the time with the proper narrative. Mention “bruxism” and “perio case”, if applicable. This is NOT TMJ – (D7880)

31 Tooth Whitening Info Tooth whitening is a per arch code! Code out upper arch D9972 at half the total fee Code out lower arch D9972 at half the total fee Effective 1/1/13 – D9972 in only for in-office whitening New Code D9975 is for at home trays/strips

32 You can take a pan starting at age 6 Use pan to illustrate growth & development For marketing – (parent shows other parents) This leaving money on the table! Much less radiation in today’s Pans than an FMX!

33 D7465 Laser Code Destruction of Lesion by Laser May pay some of the time!

34 D7288 Oral CDX Biopsy Attach the pathology report to get paid

35 D8210 Removable Appliance Therapy This can ONLY be used for thumb sucking!

36 D0431 Oral Cancer Screening Code Must be 18 years and older to bill for this screening 6%-7% of insurance carriers will pay presently but more will start to join slowly as oral cancer rate is on a steady rise due to HPV. This is done once per year.

37 Purchase the new CDT-2015 Book today! Coding With Confidence The “go to” dental insurance guide By Charles Blair Only $ Ask your Henry Schein Rep for more info


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