Staking your claim for CBCT scans
From clinical procedures to business efficiency, technology impacts the way we perform dentistry, the types of services we offer ...
Terry L. Myers, DDS, FAGD
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From clinical procedures to business efficiency, technology impacts the way we perform dentistry, the types of services we offer, and even the way our patients view our practices. Recently, when I spoke at the 4th International Congress on 3-D Dental Imaging, another speaker, Kim Innocent, discussed how to facilitate insurance reimbursement of cone beam scans. Kim has been the administrator of operations and staffing at Sudbrink Oral Surgery Associates, PC, for the past six years, and is vice president and operational advisor for Practice Concepts, LLC. She is also a certified professional coder (CPC) through the American Academy of Professional Coders.
Because my GXCB-500 HD scanner has become an integral part of my imaging armamentarium, and since reimbursement will allow more patients to take advantage of this innovation, I felt her advice would give dental practices another reason to make technology count.
Dr. Myers: Are some CBCT scans reimbursable through insurance?
Kim Innocent: Absolutely! Those who are just implementing CBCT must do some homework. Contact the insurance companies you work with to check ahead of time that your office is currently credentialed to provide CBCT scans in-office. If not, obtain the appropriate documents so you can provide services immediately. Some insurance companies require National Imaging Association credentialing that shows you have taken precautions for radiation exposure and safety issues so that the technology is controlled and not being abused. Don't be intimidated by this! Sometimes adding this technology to an existing contract takes just five minutes.
Dr. Myers: What other tips make the process easier?
Kim Innocent: It is vital to understand the coding concept, both for medical and dental reimbursement. Become familiar with medical codes such as 70486 for the initial scan and 76380 for a limited repeat follow-up study. Do some research so you understand the description codes, and make sure your documentation supports medical necessity for taking a scan. The reason for the scan and the patient's history truly drive whether the insurance company will reimburse. Don't assume the company will read the doctor's mind regarding the reason for a procedure. Always provide supporting documentation.
Submitting CBCT scans for dental insurance reimbursement is a new concept. The first dental codes for CBCT were established in 2009 and 2010. More insurance carriers recognize that 3-D imaging is becoming the standard of care for certain dental procedures and thus allow for reimbursement. But the majority of scans still fall under medical guidelines that are reimbursed through medical insurance plans. Even if a scan is covered, compliance with precertification requirements is essential. Each office should have a policy and procedure system in place, and key point people who contact the insurance companies to obtain a preauthorization number.
Dr. Myers: How is reimbursement figured?
Kim Innocent: Reimbursements are based on the office's geographical location. Typically, national averages range from $275 to $310 per scan.
Dr. Myers: What is your personal experience with reimbursement and CBCT imaging?
Kim Innocent: In the practice I manage, CBCT is becoming the standard of care, and we educate our patients so they understand that it results in the best plan of treatment and the best care possible. One of the issues we anticipate in the future is that if CBCT is available, but we don't utilize it, what are the consequences if there is a failure or complication? If you have the technology or are still considering it, make the necessary calls and verify the requirements for a seamless reimbursement process. CBCT is truly a profitable technology to have.
Dr. Terry L. Myers is a fellow in the Academy of General Dentistry and a member of the American Academy of Cosmetic Dentistry and the Dental Sleep Disorder Society. He has a private practice in Belton, Mo. Contact Dr. Myers at email@example.com.
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