LESIA CRAWFORD
SHOULD I BILL FOR AN AM ALIGNER?
AND WILL I GET PAID FOR IT?
Y
ou can bill for anything and everything as long as you have an appropriate code. No guarantee on
payment, that is up to the plan to
decide. But at this point my friends
we are in need of a better code for
the AM aligner than the options
available to us today.
If it is your professional opinion that
the AM aligner is necessary, then I
urge you fight for reimbursement of
the services you are rendering. You
have heard it before, medical billing and dental billing are like cats
and dogs, night and day. If a medical doctor thinks, or does anything,
chances are there is a code for payment. Dentists on the other hand
“just throw it in” as part of the cost.
Is it:
• Intended to be billed as the appliance to treat sleep apnea because it
moves the mandible and in conjunction with OSA diagnosis?
• To be used to bill a separate splint
or appliance moving the mandible
back in place after therapy, as a preventative measure? With the primary diagnoses code of OSA and secondary diagnosis of preventing TMJ
or other classified side effects.
If pre-authorization was required
you could submit a narrative to the
insurance explaining how the code
was being utilized. Then you, and
your patient are at the mercy of the
insurance company to decide if it’s
a covered benefit or not and if so,
does the patient meet the guidelines
for coverage?
DED, EOB, WTF?!?
DED
Abbreviation for “Deductible”
This
is how
much
the patient
is
I am
calling
on money
all dentists,
challenging youto
if you
will,
supposed
spend
outtoofcome
theirtogether
pocket
collectively
toofresearch,
case
study,
until
the benefit
insurance
actually
track
and
measure
AM
Aligners.
starts. Some plans have doctor visits
Should
they care
be considered
“stanand
preventive
available that
is
dard
of
care?”
In
the
summer
2015
not subject to the deductible. We are
of group;
Dental for
Sleep
magnotarticle
in that
us,Practice
deductibles
azine, my friend, Ken Berley DDS, JD,
usually
apply
only“YES
to OAT.
DABDSM
wrote
I file for medical
reimbursement for this device (AM
Aligner).DED
I use the TMJ code S8262.
FAM
This code is used whenever we are
repositioning
the mandible.”
“Family
Deductible”
This
codethat
waseach
also family
accepted
with a
This
means
member
TMJ
or
sleep
apnea
diagnosis.
How
has their own deductible to meet,
to
interpret
the
code
is
the
question.
but there may be a limit or cap and
once it is met by any family member
it starts benefits for the whole family.
For instance, the plan has a $1500
Unfortunately, the S8262 code has
been removed and there is no silver platter holding a replacement
EXCLUSION
FOR
DME
code.
At GoGo Billing,
we have
been
submitting for pre-authorization
with narratives with a few coding
Unfortunately,
havethe
runplans
across
options, even we
giving
an
some
medical
plans
that
have
an
option to play the “fi