Dental coding can cause a lot of headaches in dental practices, especially when the codes are updated. Staying up-to-date can be hard. Here's a code change for 2019.
The reasons that insurance companies may cover include:
• Some plans will provide a benefit for a patient suffering the effects of bruxism. • Some plans will provide a benefit for an occlusal guard, but only if the patient has a six-month prior to fabrication history of periodontal treatment, such as scaling and root planing and osseous surgery.
The reasons insurance companies may deny include:
• Failure to use one of the new 2019 CDT codes listed above • Failure to indicate on the ADA claim form the reason for fabrication of the appliance • Annual maximum has been absorbed • Frequency and limitations play an important role in coverage. Be sure to find out if the patient has a fabrication history of an occlusal guard appliance.
Always keep in mind that it is recommended the office send in a pretreatment authorization, which includes radiographs and periodontal charting, to ensure a smooth claim determination process.
With more than 22 years of experience in dental, Kyle L. Summerford has a unique approach to case presentation and patient acceptance. As an OM and financial dental consultant, he leverages his knowledge to assist new and struggling dental practices. Through his education programs, Kyle empowers staff members with effective patient education skills and persuasion techniques. He has lectured at CE events and academic institutions. His expertise is further recognized through his column, Dental Coding with Kyle. He’s the founder of the Dental Office Managers Community. Visit his website at kylesummerford.com.
