EXORBITANT DENTAL BILL? MEDICAL INSURANCE MAY COVER SOME OF IT (CONT.)
Once he investigated the matter, Dr.
Farrugia discovered that medical
insurance could be asked to cover not
just CT scans but a wide range of
services regularly performed by dentists.
He buried himself in the arcana of
coding, ultimately writing three
workbooks for dentists about medical
billing.
At first it was trial-and-error, and Dr.
Farrugia learned that claims often get
rejected if they do not cite a medically
legitimate reason for the procedure as
well as the appropriate code.
These days, Dr. Farrugia bills medical
plans $744 for a CT scan (medical code:
CPT 70486), receiving an average
reimbursement of about $500. Medical
plans generally require pre-
authorization for nonemergency CT
scans, he said, so his office staff had to
learn how to explain why the scan was
medically required — such as to assess
bone quality.
The same procedure can be billed to a
dental plan (dental code: D0367), but
the average reimbursement is $125 — if
the plan covers CT scans at all. Others
are following his example. Dr. Richard
Downs, a dentist from Iowa, attended
one of Dr. Farrugia’s medical billing
seminars last year in Chicago. “I’d never
heard these things before,” he said. He
said he recently sought and received
prior authorization from a medical
insurer for $60,000 to cover multiple
implants and other costs for a woman
whose dental woes stemmed from severe
atrophy of the jaw and other medical
problems.
During a break in the seminar, Dr.
Rashpal Deol, a dentist from San
Ramon, Calif., said Dr. Farrugia’s
approach made sense. “We look at the
soft tissues in the mouth, the muscles,
the bone, the TM [temporomandibular]
joint, and the head and neck area,” he
said. “You always check the lymph
nodes, we do oral cancer screening, so
that is a comprehensive medical exam.”
Other seminar attendees also were
enthusiastic, if a bit daunted. “People go
to school to learn medical coding,” said
Kelly Bradshaw, a staff member at a
dental practice in Santa Rosa, Calif. “To
try to bridge that gap in order to help
our patients is intimidating. You have to
be open-minded to look at things in
different ways.”
Margaret Busch, an office manager for
an Arizona dentist, said she planned to
start medical billing as soon as she
returned from the seminar.
“I’ve been making a list of people that
we can go back and probably get money
for,” she said, mentioning patients who
have had CT scans and those with dental
problems related to medical conditions
like diabetes.
“I think they’ll be excited,” she said. 䡲
Kaiser Health News is a nonprofit news
service covering health issues. It is an
editorially independent program of the
Kaiser Family Foundation, which is not
affiliated with Kaiser Permanent.
LADS Continuing Education Course March 26, 2019 | Maggiano’s 6 - 9pm
House, DDS: Mystery Diagnosis
It may not happen too often, but every once in a while, you’re stumped by an issue, problem or pain a patient
has come to you to cure. It could be unusual symptoms you haven’t seen together before, or typical symptoms that
aren’t responding to the typical treatments. Either instance, it’s a mystery.
Join fellow doctors in a game of House, DDS, as you are presented with some of the most baffling patient cases
in dentistry. This is a highly participatory presentation so come prepared to share your own diagnoses while
listening to others’ best guesses. Those who solve any of the patient cases will receive a prize at the end of the
CE! So put on your Sherlock or House thinking caps and follow the clues!
To register or obtain more information about any course, please call the LADS office or visit the LADS website.
Los Angeles Dental Society Explorer