How my office transitioned to medical billing for 3-D imaging

Do you remember your first 3-D experience? I’m not talking dental. I was an awkward nine-year-old girl with feathered bangs, a retainer, and a fashion sense that would match any worst-dressed list. As I waited among droves of tourists at Disneyland, I wasn’t sure what to expect from this “Captain EO” thing that everyone was talking about. (Yes, I know I am dating myself.) What I experienced was beyond what I had imagined. It started in 2-D, like a regular movie. When they turned to 3-D, I couldn’t help it—I reached for the flying animals that came our way and ducked when I thought something was coming at me. It was so lifelike and real!

I think the advent of 3-D imaging in dentistry was similar. I am a new(ish) owner. Believe me, when the salespeople first approached me, it took a lot of coaxing and some tense conversations. They weren’t going to trick me, and I was going to see through their BS. I wasn’t going to buy a CBCT unit just for sleep apnea. We place implants, do endo, and have a steady stream of patients. When the time came to upgrade our CAD/CAM unit, we decided to take the plunge and upgrade our pano machine as well.

And now I’m eating crow. I view the world and my patients differently, just like I did as a nine-year-old girl. All those things that the salespeople told me were true. While I still don’t use the airway volumizing function to screen for or diagnose sleep apnea, I do use it for starting a discussion with my patients and creating an awareness of the connection between dentistry and sleep apnea.

Now, how can we get paid? At first, we were going to continue what we had done previously. We would take an FMX and a 3-D image, bill insurance for the FMX, and write off everything else. We had billed medical insurance for sleep apnea for years. Why couldn’t we bill medical insurance for CBCT as well? We might as well! We’re giving it away anyway.

The excuses began: “But we’re a dental office. What if the patient doesn’t have medical insurance?” “What if the patient has a high deductible?” “We have to charge the same to dental as medical.” “What codes do we use?” “What if the patient gets mad?” What if, what if, what if . . . ?

We took a course, we started collecting medical and dental insurance cards from every patient who walked in the door, and we began to bill. We are finding out which companies will cover scans and which ones require preauthorization, but we are getting some approvals as well as denials. We can bill the exams to medical and keep as many dental benefits as possible for dental-related work. A 10% to 15% rate of approval is expected. The approval rate used to be much lower, but as CBCT scans become commonplace, medical insurers are developing policies and guidelines.

As I have said in previous articles, medical insurance is a little different from dental insurance in that preauthorization is sometimes required—mostly because you absolutely need to have a diagnosis code when submitting claims. Recently, we were asked for a physician or midlevel provider referral. Table 1 shows a complete list of what is needed to submit a claim.

The code we submit to insurance for the image is 70486. In addition, we bill a 3-D interpretation (76376) with the code. Many diagnosis codes can be used. Diagnosis codes have an order of importance that will ensure better coverage, so use any abnormal findings as priority. If a patient has a scan within normal limits, we submit the oral cancer screening code Z12.81 as a last resort. A simple Google search will give you a complete list of codes; see Table 2 for a few examples.

It took us a while, but now every dental hygienist and dental assistant takes notes in SOAP (subjective, objective, assessment, plan) format. That is what medical insurance requires for documentation, and it really should be the standard in dental documentation as well. Don’t forget to bill the new patient exam or limited emergency exam and save as many dental benefits as you can for actual restorative treatment.

Our transition into billing wasn’t as smooth as I would have liked, and many questions came up, but I will tell you this: you miss 100% of the shots you don’t take. Get trained (for example, at a 3D Dentists Medical Billing seminar), find an attentive team member who likes a challenge, and get the rest of the team writing SOAP notes. Plus, you can always use a third-party biller. I think Captain EO said it best: “We’re gonna do it right this time because we’re the best.”

Erin Elliott, DDS, is a practicing general dentist in Post Falls, Idaho, where she has successfully integrated dental sleep medicine into her busy general practice. She lectures extensively and leads a hands-on workshop focusing on practical strategies for successful implementation of sleep medicine into the general practice. She is an active member of the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine. She is a past president and diplomate of the American Sleep and Breathing Academy. Contact her directly at [email protected].