Endodontics and billing through medical insurance

Christine Taxin offers some direction on billing endodontics through medical insurance. Changes in certain insurance plans may include dental treatments!

Christine Taxin discusses several ways endodontists can bill through medical insurance

Endodontics has evolved over the past decade, and its applications continue to improve the quality of dental treatment. Endodontics involves either preserving part, or all the dental pulp in health, or removing all the pulp in irreversible disease. Not only does endodontics involve treatment when a dental pulp is present, but also includes preserving teeth which have failed to respond to non-surgical endodontic treatment, or for teeth that have developed new lesions, e.g., for when retreatment or periradicular surgery is required. With the advent of new developments in the field of endodontics, there are new and exciting ways to bill for medical including for:

  • Acute alveolar abscess
  • Root pulp damage
  • Dental implant removal

There are reasons for adding medical billing with diagnostic codes; in fact, your updated ADA coding books have the diagnostic codes in them currently.

The changes in Medicare Advantage plans being supported by every insurance company may include dental treatments; however, if your patient only has medical, or you are told by dental plan to bill medical, what can you do?

The insurance industry is changing its dental coverage to support the patient with additional hygiene visits and with the medical involving more of the need to rid the patient of infections and or help them to build back function.

CBCT scans are covered by all medical plans, so whether you are charging your patient or not for this imaging, make sure you document the imaging, obtain a signed form indicating that they understand you are not billing, and allow them to bill if you are not. Remember patients who are covered by Medicare should sign a form letting them know you are not billing for this procedure.

You must be open to collaboration from the medical providers to achieve the goal of patient health. For pregnant women, that is one of the reasons for adding the letter from an ob-gyn. It is important to recognize that an infection in a pregnant woman can spread through her system and directly affect the unborn child. Offices that treat patients with conditions such as diabetes, heart conditions, lupus, arthritis, or women who are pregnant can have medical insurance cover the treatment since the infection can spread through the body. In medically compromised patients, an added bacterial load can cause key issues.

There are several treatments that are covered under medical insurance. Notice none of the covered services are the traditional root canal therapy.

Trephination is not a common procedure, but it can be useful. Here are situations when trephination might be considered:

Acute Alveolar Abscess: Surgical trephination to reduce swelling and drain pus is considered when periapical drainage is not effective or possible.

Root Pulp Damage: Trephination can offer access to the root canal system if dentin has begun to fill the canal due to trauma or decay. If the dentin has filled the canal completely, however, trephination might not be feasible.

Dental Implant Removal: If a dental implant is fully integrated but beginning to fail, they can be quite difficult to remove. Trephination is an option if a fully integrated dental implant is beginning to fail.

  • 42310 Drainage of abscess; submaxillary or sublingual, intraoral
  • 42320 Drainage of abscess; submaxillary, external

In 42310, an intraoral drainage of a submaxillary or sublingual gland is performed. In 42320, an external (extraoral) drainage of a submaxillary gland abscess can be performed.

The complications within the endodontic world have the ICD10-Codes to help you bill for your patients.

  • 51 Perforation of root canal space due to endodontic treatment
  • 81 Cracked tooth
  • 1 Necrosis of pulp
  • 2 Pulp degeneration
  • 6 Periapical abscess with sinus
  • 8 Radicular cyst
  • 81 Primary occlusal trauma
  • 82 Secondary occlusal trauma
  • 89 Other specified disorders of teeth and supporting structures
  • 5XXA Fracture of tooth (traumatic), init for clos fx
  • 5XXB Fracture of tooth (traumatic), init encntr for open fracture
  • 5XXS Fracture of tooth (traumatic), sequela

Billing endodontics through medical insurance is one way to help finances in the dental practice. Training in all areas of the office can keep every aspect running smoothly. Read Dr. Sam Kratchman’s article, “Training and education encourage full potential” to be reminded about how important it is to stay current and keep training. https://endopracticeus.com/training-and-education-encourage-full-potential/

Christine Taxin is the founder and president of Links2Success, a practice management consulting company to the dental and medical fields. Prior to starting her own consulting company, Taxin served as an administrator of a critical care department at Mt. Sinai Hospital in New York City and managed an extensive multi-specialty dental practice in New York. With over 25 years’ experience as a practice management professional, she now provides private practice consulting services, delivers continuing education seminars for dental and medical professionals and serves as an adjunct professor at the New York University (NYU) Dental School and Resident Programs for Maimonides Hospital.

Taxin is passionate about helping dental practices reach their highest potential and increase their profitability. In her consulting work, she focuses on helping practices strengthen their communication skills, their ability to work as a team and their capacity to set goals. As a provider of continuing dental education, Taxin has been a guest speaker for Henry Schein®, Kodak Dental, Sirona, and Goetze Dental. She has presented programs to the American Association of Dental Office Managers, the PennWell Dental Group, and the New York Academy of General Dentistry. The AGD has approved her company Links2Success as a national provider of PACE continuing education credits.

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