Tuesday, October 1, 2013

Five tips on proper coding to insurance


Last week, I attended one of my favorite conferences of the year … the American Association of Dental Office Managers (AADOM) annual meeting. This conference is built specifically for office managers and is chock full of course for practice management, leadership, HR, technology, and personal growth. There were more than 600 attendees and the vendor booths spilled out into the hall.

One of the courses I attended was Dr. Charles Blair’s coding class, “Stay out of Jail – Avoid Coding Errors and Excel in Insurance Administration.” Go back to last week’s blog post and you can watch my video interview with Dr. Blair. Today, I want to give you the top five “pearls” I took away from his class.
  1. Code what you do – Even if you know the insurance company is going to downgrade to a lower procedure code, make sure you are billing the insurance company the procedure that you provide to the patient. Your clinical notes and the billing should match.
  2. Biopsy – Bill out the biopsy procedure at the time you receive the report back from the lab, not at the time you take the biopsy.
  3. Crowns prep or seat date? – If you are in-network, you must go by their rules. If you are out of network, you can bill by your rules. Double-check with your insurance contracts. If you can bill at the prep date, then do it. I have always billed crowns out at the prep date (we are out of network for all insurance companies) because this is when we incur the majority of our costs and this is also when I want the patient to pay.
  4. Bill D1110 based on dentition not age – We all know that insurance companies will not pay for an adult prophy until the age of 14, but what if your 11-year-old patient has full dentition? According to Dr. Blair, you would bill out the adult prophy and let the insurance company downgrade it.
  5. D0180 … not just for the periodontist – Many general dentists do not use this code because they believe it can only be used at a specialist office, but this is not so. Your office can use this code for any patient who has risk factors (smoker, diabetic, etc.) and possibly get paid a higher fee. You must also justify using this code with a perio chart.

Dr. Blair is an expert in coding and has many resources from which your office can benefit. My favorite is the Insurance Solutions Newsletter. For more information, visit his website by CLICKING HERE.


Dayna Johnson, Certified Dentrix Trainer
Dayna loves her work. She has over 25 years of experience in the dental industry, and she’s passionate about building efficient, consistent, and secure practice management systems. Dayna knows that your entire day revolves around your practice management software—the better you learn to use it, the more productive and stress-free your office will be. In 2016, Dayna founded Novonee ™, The Premier Dentrix Community, to help cultivate Dentrix super-users all over the country. Learn more from Dayna at www.novonee.com and contact Dayna at dayna@novonee.com.


10 comments:

  1. Hi! Nice work with your site, think you have some really great information here. Hope you don’t mind if I link to you, I’m working on a site offering promotion advice and am trying to expand my network. Keep up the good work! Cheers.

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  2. If I bill D1110 based on dentition and the insurance company downgrades it, wouldn't I have to make an adjustment? If so, why don't I just bill based on age if insurance company will downgrade it anyways?

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    Replies
    1. You should always bill to the insurance company what you do not based on their plan provisions. Since the D1110 is determined on dentition you will want to bill a D1110 if the patient has full adult dentition not if they are 14 years old. Your contract with the insurance company will determine if you need to do an adjustment.

      Hope this helps,
      Dayna

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  3. If I bill D1110 and the insurance company downgrades it, wouldn't i have to make an adjustment ? If so, why not just bill based on age if the insurance company will not pay for D1110 ?

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  4. Question - so if the insurance is a pay on seat date company. How to I file the insurance claim? Do you have any recommendations? We are currently no posting the production until the seat date, but I know this is not the correct way to do it and I want to show the production on the date it happens. Thanks in advance for your help.

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    Replies
    1. I would recommend posting the production on the impression date and collecting the patient portion. When you seat the crown then batch up the claim, attach the image and send the claim.

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  5. I have a question about bilking the insurance for the crown. If we prep a tooth for a crown in may and our clinics note shows that but we do not seat the crown until June what date should be on the claim? The seat date or the prep date that matches our clinical note?

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  6. Question about claim submission for a crown. Do we submit the DOS on the claim with the prep date of the crown or the date the crown was seated? If we prepped a crown in may and didn't seat until June what date will go on the claim for DOS? I know that our clinical notes should match the claim dates so if our mates show the prep was May should the DOS also have May?

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  7. My recommendation is to post the ADA code on the day you prep the crown and write in the seat date in the Remarks for Unusual Services. The day you take the final impression should be the DOS.

    Hope this helps,
    Dayna

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  8. The day you prep the crown will indicate that you took the impression for the crown and in my opinion this would be the day you would bill out the ADA code and charge the patient. Then your clinical note on the seat date would indicate that the crown was seated and your charge to the patient would be zero. You would need to create an "in-office" ADA code for crown seat.

    Hope this helps,
    Dayna

    ReplyDelete