Dental Sleep Medicine Insider September 2015 | Page 14
MYSTERIES
OF MEDICAL BILLING
IN THE DENTAL WORLD
Dr. Tara Griffin is a partner with Dr. Gy
Yatros at Dental Sleep Solutions. She is
a 1998 graduate of the University of
Kentucky College of Dentistry. Over the
past three years she has limited her
practice to dental sleep medicine and
the management of TMD. She holds
professional
memberships
in
the
AADSM, AAOP, AASM, AHS, AAPM,
and the ADA. She can be contacted at
[email protected].
Those of us who treat TMJ disorders and orofacial pain (OFP) understand the role dentists
play in improving our patients’ quality of life.
We understand the meaning of “living a life free of pain” and
want to help our patients any way we can. It is no secret that
getting paid for our time and expertise when treating TMD is
not an easy task. Dentists are becoming increasingly frustrated
that medical payers will cover treatment of OFP and headaches
by a neurologist but not a dentist. It can also seem obscene
when insurance will cover a $50,000 TMJ surgery for a patient
but not a conservative nonsurgical procedure such as a splint.
Laws and rules for medical billing vary from state to state. For
this reason, the services of a medical billing company can be
invaluable when treating TMD. Due the variation in coverages
and rapidly changing world of medical coding, an inquiry into
whether the recommended procedure is a covered benefit is
needed. This is difficult because while most insurances no
longer accept the S8262 code for a TMJ splint, a few still do
although that is likely to change soon.
So what codes should be used now?
That’s difficult to say.
Some allow the D7880 code to be billed while others only recognize 21085. One insurance may have a TMJ exclusion on oral
appliances but will cover the splint if it is documented for head
or facial pain and not a TMJ disorder. A medical billing company
can verify benefits and exclusions using specific diagnosis codes
and procedures codes to determine what is covered. They can
find out which procedures may meet specific insurance’s
definition of medical necessity (ex. splints, TENS, low level laser,
injections) or is it more beneficial to do a global fee for “all
inclusive TMD therapy” vs. billing adjustments separately?
It is for these reasons that consistent
documentation of medical necessity with
diagnosis codes is key when attempting to get
medical insurance to reimburse for TMD treatment.
Dr. Tara Griffin
Submitting a successful preauthorization request as well as a
successful medical claim for TMD is not an easy task. Many
medical insurances are requiring submission of claims electronically and do not process written claims. Gathering the necessary documentation and putting into a format that
will support your diagnosis and medical necessity can be
challenging. This is where utilization of a software specifically
designed for dentists to medical bill for TMD treatment and
sleep apnea appliances is critical. Having it done right the first
time will save a lot of time and frustration down the road,
especially if a medical insurance company decides it wants to
audit your records.
While working with medical insurance can seem like an uphill
battle, we are fortunate to have organizations such as the AAOP
and AACP fighting for all dentists to streamline TMD coverage.
The life-changing treatments we can provide
for sleep apnea and TMD sufferers deserve
the same recognition as those provided by
other healthcare practitioners.