Uniquely orthodontic medical billing

Current Issue , Practice Management


Editor’s intro: For offices that provide cutting-edge technologies and sleep-related treatment plans, it is important to be aware of new-age billing codes to allow for imaging and appliances that treat this wide array of patients.


Christine Taxin discusses coding for the new age of orthodontics

In the category of billing in the dental field, gone are the days of simple cases and one type of coding. As each practice becomes more of a wellness and total oral healthcare provider, dentists are providing treatment plans for a wide array of patients. Orthodontic care is just one of these specific examples.

In the modern dentist’s office, you will find that 4 out of 5 offices now own a CBCT scanner, which can diagnose and show so many needed details for requesting either traditional or alternative treatments in the orthodontic world. 3D imaging is quickly evolving as the standard of care in orthodontics as new ultra-low-dose CBCT technology offers safer and more affordable volumetric scanning than ever before. The advantages of CBCT over traditional 2D imaging are many, including:

There are many dental codes for temporomandibular issues and cone beam necessity, but billing to medical will allow the clinician to use additional codes both during the case and at the end of case for documentation and medical necessity.

Examples of these codes include:

For the code 70486, Cone beam CT capture and interpretation with limited field of view — less than one whole jaw, list the conversion with the following. Use the following for code 70486:

In addition to orthodontic care, and while striving to provide complete patient care, another course of treatment many dentists are providing relates directly to sleep apnea. Since the inception of the American Academy of Sleep, an uptick in the number of oral physicians providing sleep apnea care has increased. Many dentists have taken courses and have become providers of durable medical equipment. This means that they are directly involved with medical billing. The good news is that billing for this specific area is quite straightforward, as there is only one diagnostic code for sleep apnea for both adults and children. The code G47.33 must be listed as the diagnosis on the sleep test or it will not receive payment.

Along with orthodontic care and the monitoring of sleep apnea, dentists need to be mindful of snoring and how appliance placement can possibly aggravate this condition in patients. The American Academy of Craniofacial Pain Task Force on Mandibular Advancement Oral Appliance Therapy for Snoring and Obstructive Sleep Apnea has a specific stance on just how appliances might increase the overall struggle with snoring. The OSA published a position paper in 2013 that states oral appliance therapy has the potential to cause TMD and that orthodontic specialists should be engaged in treatment of both OSA and TMD with expanders that can be watched as the child grows to prevent TMD.1

There are steps that you can implement to begin the journey of adding the ability to help screen a child for either treatment of sleep apnea or TMD. Of course, you must determine the treatment after the test results are available and collaborate with your patients’ medical provider.

Some patients either do not want to go for a sleep test, or you may want to recommend the use of an expander for the opening of a small airway and still bill to medical as either a sleep appliance for a child or a TMD appliance. When treatment planning for TMD, bear in mind that reversible intraoral appliances (i.e., removable occlusal orthopedic appliance-orthotics, stabilization appliances, occlusal splint, bite appliances/planes/splints, mandibular occlusal repositioning appliances) are or could be used for different reasons, but all are acceptable by insurance. Reversible intraoral appliances may be considered medically necessary in selected cases only when there is evidence of clinically significant masticatory impairment with documented pain and or loss of function. There needs to be a result of 6-8 months of monitoring prior to the application of appliance. The clinician cannot use words such as bruxism (because bruxism is a habit that can be broken so it doesn’t quality) or sports guard (because the sports guard is only worn to protect teeth while playing a sport). Each case must be pre-authorized.

The diagnostic coding for most TMD treatment plans is listed with the insurance policy. You need to check each patient’s policy for the following information:

The following nonsurgical treatments may be considered medical necessary in the treatment of a TMJ disorder:

The following ICD-10-CM Codes are related to this specific billing:

Cross Codes:

All billing requires a Salzman Index to even get a pre-authorization or a sleep study. Next, all information must be completely documented in the form of a narrative template in a S.O.A.P format.

S. Subjective information must be gathered: When the patient is calling to make an appointment, there are several key questions to ask.

O. Objective: During your objective part of the visit, you must have a history and physical and /or consultation notes including:

A. Assessment: Reading of all tests taken, Salzman Test, CT scan of the soft tissue of neck area, and the sleep test done with a monitor in an overnight sleep lab.

P: Plan of Action:

A final note: When billing some of the common appliances orthodontists make (soft and hard stabilization appliances, anterior positioning appliances, anterior bite appliances, and soft resilient appliances), you may need to use an unlisted code, and in your letter of medical necessity, you must write the entire description the dental code. You also may need to use the dental code on the medical claim since there are dental codes that are not cross coded but are covered with the correct diagnostic reason.2

All codes are owned by the ADA and the AMA and are copywritten by them. I have permission to teach and help providers understand the codes.[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner][vc_column_text]

Christine Taxin has more guidance for new age billing of OSA and TMJ here.