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
You can purchase coding manuals from the American
Medical Association (www.ama-assn.org).
HCFA 1500 forms can be purchased from any medical-office
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
• 99203 (Detailed history and exam—30
• 99204 (Comprehensive history and exam—45
CPT-2005 codes for established patients:
• 99212 (Problem focused— 10 minutes)
• 99213 (Expanded problem focused—15
• 99214 (Detailed history and exam—25
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
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
• 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
• 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
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
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
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.