They are the reason for the million-dollar questions asked at nearly every dental meeting. What are “they”? They are dental lasers, and as dentists learn more about how they can benefit the practice, their interest in laser dentistry grows. So what are some of those million-dollar questions?
1. If I buy this “Whiz-Bang Model 1501” high-tech dental “gizmonotron,” how do I bill for it?
2. What insurance code do I use so the insurance company will pay a benefit for services done with the laser?
3. Can I bill the patient’s medical plan?
4. 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 for 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 which identifies the completed procedure. That code is D7465, destruction of lesion(s) by physical or chemical method, by report. Examples include using cryo, laser, or electrosurgery. Code D7465 is the one and only procedure code that is specifically technique-sensitive to the laser. Rather than being surgically removed, the pathological 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 (four or more teeth) or D4211 (one to three teeth).
We must remember that a laser is nothing more than an adjunctive instrument utilized to complete a more definitive procedure. You would not routinely 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’ reimbursements are based on 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 successfully used 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, opthalmology, neurosurgery, 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 of experimental and investigatory status of advanced therapies.
More dentists would be inclined to buy lasers if, in addition to soft-tissue procedures, they 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, undertrained 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.
In conclusion, you make (more) money with a dental laser by being able to do the completed procedure with greater efficiency. In other words - faster, cleaner, better, more efficient use will make the procedure more cost-effective, providing a greater return on your investment.
See you on the road!
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.
