Five tips on proper coding to insurance

Last week, I attended one of my favorite conferences of the year … the American Association of Dental Office Managers (AADOM) annual meeting. This conference is built specifically for office managers and is chock full of course for practice management, leadership, HR, technology, and personal growth. There were more than 600 attendees and the vendor booths spilled out into the hall.

One of the courses I attended was Dr. Charles Blair’s coding class, “Stay out of Jail – Avoid Coding Errors and Excel in Insurance Administration.” Go back to last week’s blog post and you can watch my video interview with Dr. Blair. Today, I want to give you the top five “pearls” I took away from his class.

1. Code what you do – Even if you know the insurance company is going to downgrade to a lower procedure code, make sure you are billing the insurance company the procedure that you provide to the patient. Your clinical notes and the billing should match.
2. Biopsy – Bill out the biopsy procedure at the time you receive the report back from the lab, not at the time you take the biopsy.
3. Crowns prep or seat date? – If you are in-network, you must go by their rules. If you are out of network, you can bill by your rules. Double-check with your insurance contracts. If you can bill at the prep date, then do it. I have always billed crowns out at the prep date (we are out of network for all insurance companies) because this is when we incur the majority of our costs and this is also when I want the patient to pay.
4. Bill D1110 based on dentition not age – We all know that insurance companies will not pay for an adult prophy until the age of 14, but what if your 11-year-old patient has full dentition? According to Dr. Blair, you would bill out the adult prophy and let the insurance company downgrade it.
5. D0180 … not just for the periodontist – Many general dentists do not use this code because they believe it can only be used at a specialist office, but this is not so. Your office can use this code for any patient who has risk factors (smoker, diabetic, etc.) and possibly get paid a higher fee. You must also justify using this code with a perio chart.

Dr. Blair is an expert in coding and has many resources from which your office can benefit. My favorite is the Insurance Solutions Newsletter. For more information, visit his website by CLICKING HERE.