Dentaltown January 2017 - 47

My main questions: Does the insurance company reject the 8999 code? Does it limit the
amount that can be paid in the 8999 code? At what point do you know if the 8999 code is
covered (can you get it predetermined)?
We have submitted priors for the 8999 code and all that they ask for is a short three-sentence
narrative. I should know soon if this is a good solution. ■
8/4/2013

Just tell the patient it's cosmetic ortho and they need to pay in full. Then unbundle for exam,
pan, ceph and records. ■

Calidds1982
Member Since: 12/01/08
Post: 97 of 115

8/4/2013

It is my understanding that you can't unbundle the codes for pan, ceph or impressions
because that is all included in the ortho fee.
Even if it is "cosmetic" ortho, you still must submit to insurance a code. What would
prevent dentists from not billing insurance for a crown and collecting full fee for it (if you are
a participating provider)? ■

drbraps
Member Since: 07/06/04
Post: 98 of 115

8/5/2013

The reality is if you are a participating provider or not with a certain insurance plan, then
you must participate for all codes. If you read the fine print, most insurances will stipulate that
the ortho code will likely include "records" and "exam," so you cannot unbundle the records unless
the patient chooses to not follow through with treatment.
Unfortunately, the allowable charge for D8040 for a
lot of plans is abysmal. The insurance companies view
all limited treatment as the same beast, whether you are
uprighting a molar, closing a diastema or aligning half
an arch.
Limited cosmetic ortho treatment of just one arch or
social six, no matter what you want to call it, cannot ethically be submitted as D8090 (comprehensive ortho) no
matter how long the treatment takes, how difficult it is,
or what you feel you are entitled to charge or be paid. It's
just one of the downsides of participating in insurance
plans. You then have to make a choice whether you want
to offer this service and make up the costs elsewhere, or
not participate in the insurance plan so you can charge
your fee for the ortho (as well as all other procedures).
The only unbundling option would be to submit a
D8999 for ceramic bracket upcharge (which they likely
won't pay and will be assumed by the patient), because
D8040 includes metal. ■

vacuefactor
Member Since: 06/13/10
Post: 99 of 115

8/5/2013

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Table of Contents for the Digital Edition of Dentaltown January 2017

CE Update
On Dentaltown.com
Study Abroad: Live CE Events
Industry News
New Products
Poll
Product Profile: Glidewell Laboratories
Ad Index
Product Profile: OCO Biomedical
The Curious History of Occlusion in Dentistry
Making a Good First Impression
Townie Meeting 2017 Preview
Howard Speaks: Suck It Up Buttercup
Professional Courtesy: Package Deal
Show Your Work: Crowning a Winner
Product Profile: Aspen Dental
Dentally Incorrect
Message Boards: Best Way to Text Patients
Message Boards: Teach An Old Guy About Perio
Message Boards: Powerprox 6-Month Braces (Trouble Getting Started)
Office Visit
Does My Patient Need A Gum Graft
Earn Your Keepers
CE Requirements by State
CE: Honing Our Edge
Dentaltown January 2017 - Intro
Dentaltown January 2017 - Cover1
Dentaltown January 2017 - Cover2
Dentaltown January 2017 - 1
Dentaltown January 2017 - 2
Dentaltown January 2017 - 3
Dentaltown January 2017 - 4
Dentaltown January 2017 - 5
Dentaltown January 2017 - 6
Dentaltown January 2017 - 7
Dentaltown January 2017 - 8
Dentaltown January 2017 - 9
Dentaltown January 2017 - On Dentaltown.com
Dentaltown January 2017 - 11
Dentaltown January 2017 - Howard Speaks: Suck It Up Buttercup
Dentaltown January 2017 - 13
Dentaltown January 2017 - 14
Dentaltown January 2017 - 15
Dentaltown January 2017 - Professional Courtesy: Package Deal
Dentaltown January 2017 - 17
Dentaltown January 2017 - CE Update
Dentaltown January 2017 - 19
Dentaltown January 2017 - 20
Dentaltown January 2017 - 21
Dentaltown January 2017 - Study Abroad: Live CE Events
Dentaltown January 2017 - 23
Dentaltown January 2017 - Industry News
Dentaltown January 2017 - New Products
Dentaltown January 2017 - Poll
Dentaltown January 2017 - 27
Dentaltown January 2017 - Show Your Work: Crowning a Winner
Dentaltown January 2017 - 29
Dentaltown January 2017 - 30
Dentaltown January 2017 - 31
Dentaltown January 2017 - Message Boards: Best Way to Text Patients
Dentaltown January 2017 - 33
Dentaltown January 2017 - 34
Dentaltown January 2017 - 35
Dentaltown January 2017 - 36
Dentaltown January 2017 - 37
Dentaltown January 2017 - Message Boards: Teach An Old Guy About Perio
Dentaltown January 2017 - 39
Dentaltown January 2017 - 40
Dentaltown January 2017 - 41
Dentaltown January 2017 - 42
Dentaltown January 2017 - Message Boards: Powerprox 6-Month Braces (Trouble Getting Started)
Dentaltown January 2017 - 44
Dentaltown January 2017 - 45
Dentaltown January 2017 - 46
Dentaltown January 2017 - 47
Dentaltown January 2017 - Office Visit
Dentaltown January 2017 - 49
Dentaltown January 2017 - 50
Dentaltown January 2017 - 51
Dentaltown January 2017 - 52
Dentaltown January 2017 - 53
Dentaltown January 2017 - The Curious History of Occlusion in Dentistry
Dentaltown January 2017 - 55
Dentaltown January 2017 - 56
Dentaltown January 2017 - 57
Dentaltown January 2017 - 58
Dentaltown January 2017 - 59
Dentaltown January 2017 - 60
Dentaltown January 2017 - 61
Dentaltown January 2017 - 62
Dentaltown January 2017 - Making a Good First Impression
Dentaltown January 2017 - 64
Dentaltown January 2017 - 65
Dentaltown January 2017 - Does My Patient Need A Gum Graft
Dentaltown January 2017 - 67
Dentaltown January 2017 - 68
Dentaltown January 2017 - 69
Dentaltown January 2017 - 70
Dentaltown January 2017 - 71
Dentaltown January 2017 - Earn Your Keepers
Dentaltown January 2017 - 73
Dentaltown January 2017 - 74
Dentaltown January 2017 - 75
Dentaltown January 2017 - Townie Meeting 2017 Preview
Dentaltown January 2017 - 77
Dentaltown January 2017 - 78
Dentaltown January 2017 - 79
Dentaltown January 2017 - 80
Dentaltown January 2017 - 81
Dentaltown January 2017 - 82
Dentaltown January 2017 - 83
Dentaltown January 2017 - 84
Dentaltown January 2017 - 85
Dentaltown January 2017 - 86
Dentaltown January 2017 - 87
Dentaltown January 2017 - Product Profile: Glidewell Laboratories
Dentaltown January 2017 - Ad Index
Dentaltown January 2017 - Product Profile: OCO Biomedical
Dentaltown January 2017 - 91
Dentaltown January 2017 - Product Profile: Aspen Dental
Dentaltown January 2017 - 93
Dentaltown January 2017 - CE Requirements by State
Dentaltown January 2017 - 95
Dentaltown January 2017 - CE: Honing Our Edge
Dentaltown January 2017 - 97
Dentaltown January 2017 - 98
Dentaltown January 2017 - 99
Dentaltown January 2017 - 100
Dentaltown January 2017 - 101
Dentaltown January 2017 - 102
Dentaltown January 2017 - Dentally Incorrect
Dentaltown January 2017 - 104
Dentaltown January 2017 - Cover3
Dentaltown January 2017 - Cover4
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