Dentaltown January 2018 - 85

OK, so give it to me straight.
Knowing that it will probably
be a steep learning curve,
what else do I need to know?
You've read this far, so you're ahead of
the eight-ball already and have determined
that you're willing to consider accepting
the challenges associated with negotiating
the medical billing process. First, check
out this list of the top medically billable
procedures and see how many you perform,
and whether it would be worth it to your
patients and your practice to learn the
process. Remember, whether they're "high
end" or not, most patients are paying hefty
premiums for medical insurance but aren't
utilizing the benefits from their medical
plans in dental offices, for procedures they
need, because they (and often their dental
health care providers) have no idea what's
billable or covered.
1. Any traumatic injury to the mouth,
whether dental or oral treatment
thereof. This includes all oral and
dental procedures.
2. Exams for soft and hard tissue
pathology:
* Exams and consults
in preparation for surgery.
* Exams and consults also include
visual screening exams for oral
cancer.
3. Emergency treatment of oral
inflammation or infection, such as
pericoronitis, "pizza burn," floss stuck
between teeth causing perio abscess
or draining fistula.
4. Diagnostic, radiographic
or surgical stents.
5. Medical radiographs-those in which
most of the film shows structures
other than teeth. Medical radiographs
are of two types.
* Screening (2-D) X-rays: orthopantograms, lateral jaw X-rays, occlusal
films, cephs, Waters' view.

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* If there are suspicious lesions or
positive findings on the screening
X-rays, then diagnostic (3-D) X-rays
or CT scans are taken.
Dental radiographs (periapicals and
FMX) are billable to medical plans
only in cases of traumatic injury.
Biopsies (brush, smears or removal of
part of a suspicious area) and excisions
(removal of the whole lesion).
Extraction of teeth: wisdom teeth,
supernumeraries, mesiodens, ankylosed teeth, exposure of impacted
teeth. Any teeth, if traumatic injury is
the cause. Extractions may be covered
when performed at the request of an
M.D. before specific surgeries (open
heart, transplants, hip and knee
replacements, tumor removal).
Any surgical procedure needed to:
* rebuild or reconstruct alveolar
or jawbone because of bone loss/
destruction.
* treat an infection.
Prosthetics:
* Interim prosthetics are covered
when any elective or emergency
surgery is performed.
* Both interim and definitive (final)
prosthetics are covered:
A. When treatment is
for a traumatic injury.
B. If there is a medical
condition that involves the
teeth (such as ectodermal
dysplasia, methamphetamine
addiction, bulimia, etc.)
C. When previous or current
medical treatment-for
example, medication-induced,
chemotherapy or radiation-
has affected the teeth.
Removable or fi xed appliances used
to treat dysfunction-nightguards,
TMD orthotics, palatal expansion,
habit breaking, sleep apnea, etc.

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dentaltown.com \\ JANUARY 2018

85
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Table of Contents for the Digital Edition of Dentaltown January 2018
