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Dental-Medical Cross Coding
Insurance coding: Cure for the common headache
How to make sure you get paid for providing this important treatment.
By Marianne Harper

An My article "Crack the code", which appeared in the March Dental Practice Report, provided the steps necessary to enable you to file medical claims for certain dental procedures. In that article, I noted four categories under which you may file dental procedures under a patient's medical plan: Infection that is beyond the tooth apex and not treatable by entry through the tooth; pathology that involves soft or hard tissue; procedures related to dysfunction; and emergency trauma procedures. Headaches fall under procedures related to dysfunction.

With a little modification, filing claims for treating migraines and tension headaches is very similar to other medical/dental cross-coding situations. It might be helpful to read "Crack the code."

History and documentation

First, update the patient's medical history to include the history of migraine or tension headaches. Ask your patient if a physician has diagnosed the problem. If the answer is no, recommend that the patient pay a visit to his or her family physician before you begin treatment planning.

Document any prescribed medications and medical tests, as well as how successful treatment has been. Additionally, document the symptoms and sensations the patient has experienced with the headaches. This information will be needed, not only in the treatment planning, but also in the writing of a strong narrative for the claim.

Obtain benefit information

Once treatment is planned, you will need to follow the steps listed in "Crack the code" for obtaining the medical insurance information from the patient. The pre-certification step will be an excellent tool to enable you and your patient to know in advance if a treatment device will be covered. In most cases, this can be successfully accomplished by phone or fax. The CPT-2005 code most often used for intraoral devices is 21110-52 (Interdental fixation device. "-52" is the modifier). BlueCross BlueShield accepts code D7880.

You can purchase coding manuals from the American Medical Association (www.ama-assn.org). HCFA 1500 forms can be purchased from any medical-office supply store.

How to file claims

In addition to filing for the appliance, you should initially file for the exam. You can choose from the following exam codes.

CPT-2005 codes for new patients or patients who have not been seen in over three years:

• 99202 (Expanded problem focused—20 minutes)

• 99203 (Detailed history and exam—30 minutes)

• 99204 (Comprehensive history and exam—45 minutes)

CPT-2005 codes for established patients:

• 99212 (Problem focused— 10 minutes)

• 99213 (Expanded problem focused—15 minutes)

• 99214 (Detailed history and exam—25 minutes)

You will need to enter the ICD-9-CM code (these are diagnostic and surgical codes used to establish a medical necessity) 346.10 for patients with common migraines, but you can use code 350.2 (atypical facial pain) for both migraine and tension-headache patients. Place the code in box 21 of the HCFA 1500 (medical insurance claim form). Fill in the remaining entries on the HCFA 1500 as explained in the sidebar of my March article.

After the therapy has begun, file a claim for the appliance using the codes listed above. All patients who are receiving this therapy should receive periodic supervision, as patients can possibly experience muscle soreness, changes in the way the teeth fit together or loosening of teeth; these will require adjustments. These visits can also be filed using the CPT-2005 established patient codes.

Attach a narrative

Claims should be accompanied by detailed narratives following the SOAP format (subjective, objective, assessment, plan) and included with information obtained from the patient's medical history. It would facilitate the process if you would create a template to be used with each narrative that would list:

• A description of the type of appliance;

• the patient's complaint;

• the physician's name and phone number;

• treatment rendered to date;

• symptoms and sensations, history, location and frequency of the pain;

• your diagnosis and the diagnosis of the physician; and

• your treatment plan. If you're treating the patient with the Nociceptive Trigeminal Inhibition-tension suppression system (see "How to…" page 25), state that the device is FDA-approved for marketing for prophylactic treatment of migraine pain.

Track your claims

Follow up on outstanding claims and carefully inspect EOBs in the same manner that you would with dental claims, looking for denials or errors.

If the claim is denied, insist that the insurance company give you the reasons for denial. If a phone call does not produce the desired results, send a letter requesting an explanation of the denial so that you may make any necessary corrections and ask for a reconsideration of the claim.

By law, the insurance company cannot discriminate against you because you are a dentist.

If the policy states "no dental claims," advise them that it is a medical claim. Your last resort will be to have your patient contact the state's insurance commissioner.

If you are not inquiring about the headache history of all of your patients you may be missing a great opportunity.

With appliance therapy as part of an integrated headache-treatment program and the ability to file medical claims, you can give your patients more out of their insurance plan, grow your practice with increased revenue and case acceptance for these procedures, and have the peace of mind that comes from helping your patients with chronic pain.

Related Links: Weigh treatment options ; How common are headaches? .

Posted by dentalproducts.net. Originally published in the June 2005 Dental Practice Report. Copyright 1999-2005 Advanstar Dental Communications.

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