What is the Primary Diagnosis?
A potential obstacle in dentistry is the success to billing medical insurance is in our field of view. To be successful at medical billing and having dental procedures covered under medical insurance, It’s time realize how powerful the oral systemic link is and their connection. Dentistry has mastered the art of detecting even the smallest problem in most cases. This isn’t even something medical professionals do very well. The problem with focusing on the micro is that when you magnify something too big, you can easily lose track of the bigger picture. Dentistry has been so focused on early detection that we have lost our view of prevention. Virtually everyone who has teeth has the same bacteria that causes periodontal disease. Why is it that some people can prevent the bacteria from destroying bone and others, despite good home care and more frequent trips to the dentist for maintenance cannot? In the dental profession the definitive diagnosis would be periodontal disease and go no further. Periodontal disease is, in many cases can be linked to an underlying medical condition.
Medical insurance pays for treatment of symptoms as a result of a medical condition. We see diseases present in the mouth every day such as diabetes, G.E.R.D., osteoporosis, and heart disease. There are also many other contributing factors to oral dysfunction. When a patient informs us that they have cancer and are going to undergo treatment, dentists recommend fluoride because we know that we consistently see chemotherapy and radiation treatments causing problems in the mouth. The good news is that medical insurance knows this too. Most procedures linked to the treatment of cancer are almost always covered under medical plans.
When I first started billing medical insurance in the dental practice where I worked, we saw a patient on short notice because she felt like a crown was loose. After clinical examination, it was revealed that this tooth had 8 and 9mm pockets and removal of the tooth was required. Most dental professionals would agree that periodontal disease is to blame in this case but looking through her previous treatment notes, I discovered that this was the third tooth that required removal from this disease in the past few years. Looking over her medical history, I found a side note stating she had a mastectomy. The only reason I could come up with for a mastectomy was cancer. I asked the patient if she had underdone chemo or radiation and she said yes to both. She had been a patient since 2006 and was diligent about keeping up with her cleaning appointments. Her history showed that although she did show signs of inflammation, there was no bone loss reported. After her treatment of cancer, her inflammation went from controlled to progressive. Using cancer treatment as the proper primary diagnosis, I was able to obtain an approval for the replacement of all three teeth with dental implants in determining the medical necessity . The total paid by medical was more than $15,000!
Once we are able to expand your field of view to start thinking outside of the mouth and thinking about the body as a whole, a door will unlock. Not only will we be rewarded with staggeringly higher reimbursements, we will also be able to provide a whole new level of patient care to our patients. Medical thinking will not only allow us to provide the clinical expertise our patients have come to expect but we will also be reimbursed appropriately for the services we provide.
Danielle and Jill
Written By: Jill Coon
Time to Make the Paradigm Shift
Just recently, I had the pleasure of speaking and attending the ACE (Academy of Comprehensive Esthetics) meeting in Las Vegas. The first day, I listened to other speakers who talked about dentistry and the body as a whole. Speakers were saying that we need to change our thinking about the way we practice dentistry and begin thinking about the patient’s total health not just focus on drilling and filling or scaling teeth right away. The way we have been doing or looking at things over the years is now changing dramatically.
Dr. Bradley Bale M.D. caught everyone’s attention. Dr. Bale is a cardiologist who definitely understands the link between cardiac disease and periodontal disease. Did you know that endodontic disease and caries also trigger a significant percentage of heart attacks? The American Heart Association has research showing the direct connection between oral pathogens (associated with periodontal disease, endodontic lesions, and caries) and acute heart attacks! Almost half of heart attacks are being triggered by oral pathogens. Oral bacteria were found in every thrombus, and 30% had live oral pathogens in the clot. Dental infection and oral bacteria are associated with development of acute coronary thrombosis. Oral health and dental care should be part of heart attack prevention and more. We need to encourage greater collaboration between the medical and dental professions. In doing this paradigm shift, our dental procedures become medically necessary thus making some of our procedures now billable to our patient’s medical insurance. The use of cross coding in your dental software makes billing medical insurances much easier.
Dr. Sam Low D.D.S., a periodontist and a professor at the University of Florida, College of Dentistry, spoke abut achieving restorative/periodontal success by controlling inflammation. Dental infection and oral bacteria are associated with inflammation. We all have the bacteria in our mouth but some people are more susceptible to inflammation than others. Why is this? This is what we need to find out when reviewing our patient’s medical history rather than smoothing root surfaces because of calculus and plaque or just filling teeth. Are your patients taking medications that cause dry mouth, making them more susceptible to bacteria and decay or do they have certain diseases or conditions that cause breakdown of teeth or bone?
During my presentation, I spoke about The Missing Link to The Insurance Puzzle and tied together the use of medical and dental billing in relation to your patient’s total health. I explained how and why cross coding is needed in the dental practice and how it is beneficial to both the patient and the practice. Below are several images (images modified and courtesy of Marianne Harper-The Art of Practice Management) from my presentation at ACE this past weekend of medically billable procedures in your dental practice:
Of course before you start billing anything to medical insurance, you will need to check on your patient’s insurance eligibility and coverage. For information on cross coding and medical billing, please don’t hesitate to contact us.
Written By: Jill Coon
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