Lasers and insurance
by Tom Limoli Jr.
They are the million-dollar questions asked at almost every dental meeting:
"If I buy this 'Whiz-Bang Model 1501' high-tech, dental giz-mon-o-tron, how do I bill for it?"
- "What code number do I use so the insurance company will pay benefits?"
- "Can I now bill the patient's medical plan?"
- "How do I make (more) money with a dental laser?"
Let's take these issues one at a time. In a true fee-for-service environment, we simply identify and subsequently bill each completed procedure. The operative word here is completed. What did we do? Production, billing, and subsequent collections are based on the procedure, not the technique.
Dental lasers have two primary functions: they cut and they destroy. So what are we cutting? And, what are we destroying? If we are destroying a lesion, we have a specific code that identifies the completed procedure. That code is D7465, defined by the CDT-3 code book as the destruction of lesion(s) by physical or chemical method, by report. Examples include using cryo, laser, or electro surgery. Code D7465 is the one and only procedure code that is specifically technique-sensitive to the laser. Rather than being surgically removed, the pathologic lesion is simply obliterated.
For all other procedures where the laser is used, report the code that most accurately describes the intended procedure. For a frenectomy, the code is D7960. For a gingivectomy, the code is either D4210 (per quadrant) or D4211 (per tooth).
We must remember that a laser is nothing more than an adjunctive instrument that is utilized to complete a more definitive procedure. You would not explain on a claim that you used a No. 11 or No. 15 Bard-Parker blade. Your treatment notes, however, are another story.
Benefit plans reimburse based upon the completed procedure. They accept no additional liability for the use of a laser. The same holds true for the use of a curved or straight blade. With the exception of D7465, CDT codes identify completed procedures, not specific techniques.
Lasers have been used in general dentistry for many years. Most of the dental laser products are identical in design to those which have been used successfully for more than 25 years in the medical/hospital environment. Our medical peers have at their disposal technique-sensitive procedure codes in the fields of general surgery, ophthalmology, neuro-surgery, ear/nose/throat (ENT), and dermatology. In the dental realm, we have no such luxury of coding specificity. In other words, leave the patient's medical plan alone!
The Food and Drug Administration (FDA) does not control what practitioners do in their offices once they have purchased a laser; the FDA only controls the applications for which laser manufacturers market their products. The only true control of laser use is through state dental boards and peer review mechanisms of evaluation, experimental, and investigatory status of advanced therapies.
More dentists would be inclined to buy lasers if, in addition to soft-tissue procedures, lasers could be more cost-effectively used for removing fillings, sealing teeth, desensitizing teeth, removing caries, performing root-planing and scaling procedures, as well as sealing off apical ends of endodontically-completed obturations. However, untrained dentists are using lasers in ways that are not approved by the FDA. This misuse only serves to further complicate the progress of laser use.
So what does this all mean to your practice's bottom line? It means you make (more) money with a dental laser by being able to do the completed procedures with greater efficiency. In other words, doing a procedure faster, cleaner, better, and more efficiently will be more cost-effective and profitable.
Tom Limoli Jr. is the president of Atlanta Dental Consultants and the editor of Dental Insurance Today, a bimonthly publication that addresses third-party reimbursement in the dental office. He also is the author of Dental Insurance and Reimbursement Coding and Claim Submission . He can be contacted by phone at (404) 252-7808. Visit his Web site at www.LIMOLI.com.