Dental coding with Kyle: Provisional splinting
Dental coding is tricky sometimes. That's why it's important to get it right and receive reimbursement for your practice.
D4320—Provisional splinting, intracoronal
D4321—Provisional splinting, extracoronal
The purpose of provisional splinting is to stabilize mobile (loose) teeth and maintain them in the position before periodontal surgery due to bone loss.
The teeth are cleaned and isolated, no anesthesia is typically used, but in some cases the teeth will be cut and anesthesia must be used. There are different types of splinting materials, with the most common being metal wire or braided fibers. The “wire” is then placed along the teeth and bonded and cured.
There are many variables involved when it comes to dental insurance coverage and reimbursement.
• Dental insurance companies will usually only cover “permanent” procedures, and according to insurance companies a splint is considered a temporary prosthesis.
• If bone loss is visible on x-rays, the dental insurance company may suggest the treatment is unnecessary in order to avoid paying for it. The company may provide benefits toward a tooth extraction instead.
• Submitting a clear written narrative that explains the benefits of splinting, and outlining the treatment plan with the desired prognosis, can help facilitate approval in some cases.
• Providing x-rays, narrative, recent periodontal charting, and photographs will ensure a smooth claims process.
It is very important for you to remember this: Even though the insurance company may not pay for a particular procedure, this does not mean that the insurance company’s decision is in the best interest of the patient.
Kyle L. Summerford is a nationally recognized practice management guru, author, and lecturer. He is founder and president of Summerford Solutions Inc., and cofounder of Elitedentalclaims.com. Kyle also serves as editorial director of Pennwell's Dental Office Manager Digest e-newsletter. He lectures extensively to dentists and their staff on topics such as insurance coding and billing and useful practice management tips. Contact him at email@example.com.