Inside Dentistry
July 2016
Volume 12, Issue 7

As an example, Ghaboussi cites the growing interest in sleep apnea treatment. “A few years ago the general public was unaware of health risks of sleep apnea, but now it’s uncommon to find anyone who hasn’t heard of it,” he says. “The key point is that most of the people with sleep apnea do not have a clinical diagnosis and certainly are not being treated for it. This is one of those life-changing treatments that we, as general dentists, can do for our patients that can save lives. Most of the process of diagnosing and treating sleep apnea can be billed by a dental office, such as exams, diagnostic records (including cone beam), and even oral appliances.”

Becoming an office that accepts both medical and dental insurance offers an array of benefits for the practice, by helping patients get the most out of their insurance while minimizing out-of-pocket expenses. Ghaboussi admits that starting out in medical billing can be difficult, therefore he recommends hiring a company to help dental offices begin the process.

According to Taxin, practices need to learn the diagnostic codes for the treatment they provide. “Not every plan will require diagnostic codes, but every plan is going to require you to tell them the diagnostic tool, the reason, and the outcome—that’s the difference.”

“Patients who have systemic infections or autoimmune diseases are being told to go to their dental physician four times a year,” she adds. “Patients who have been diagnosed in the medical world become patients in the dental world. In fact, ICD-10 has specific, distinctive diagnostic codes for Diabetes and Perio, Diabetes I and Perio, and Diabetes II and Perio.”

Final Considerations

To ensure that appropriate billing codes are selected, procedures, medicines, diagnostics, and services should be carefully examined. In complex cases, some codes may be purely dental, while others are deemed medically necessary and submitted to the patient’s health insurance. When billing through health insurance, it’s important to demonstrate why and how the procedure will affect the patient’s overall health.

Clinicians planning to pursue medical billing for dental procedures should be sure they have all the resources necessary for successful reimbursement. The process can seem complicated at first, but any team can learn to navigate the process and start saving their patients significant amounts of money while providing comprehensive care.

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