Oral Cancer Screenings in dentistry medical billing

As healthcare professionals, dentists play a crucial role in preserving their patients’ dental health and detecting and preventing potential life-threatening illnesses such as oral cancer. While oral cancer screenings are becoming increasingly common in dental practices, the question of medical billing for these services remains a source of confusion and concern for many dentists.

Medical billing for oral cancer screenings is a critical aspect of dental practice that can help ensure patients receive timely and effective care. While medical billing can seem complex and overwhelming, understanding the basics can help dentists maximize reimbursement for their services and provide quality patient care.

In this post, we will closely examine oral cancer screening and medical billing for oral cancer screening. Whether you are a newbie or experienced, this will help you in several ways.

Medical billing for dentists – Oral Cancer Screenings

What is Oral Cancer Screening?

Oral cancer is a serious health concern affecting thousands of individuals yearly. It can be life-threatening if not detected early and treated promptly.

Oral cancer screening is a visual and tactile examination of the mouth and surrounding tissues to detect any abnormal growth or changes that could indicate the presence of cancer. Dentists typically perform oral cancer screenings as part of a routine dental exam. During the screening, the dentist will examine the mouth for any signs of lesions, lumps, or discoloration. They may also gently touch the mouth tissues to feel for abnormalities.

How often should an oral cancer screening be done in a patient with a history of oral cancer?

If a patient has a history of oral cancer, they need to undergo regular oral cancer screenings. The frequency of these screenings will depend on various factors, including the stage of previous cancer, the treatment received, and the patient’s overall health status.

In general, it is recommended that patients with a history of oral cancer undergo oral cancer screenings at least every six months for the first two to three years after the initial diagnosis and treatment. However, patients must discuss their situation with their healthcare provider to determine the appropriate frequency of oral cancer screenings.

Can a hygienist do an oral cancer screening?

Yes, dental hygienists are trained to perform oral cancer screenings as part of their scope of practice. According to a study published in the Journal of Dental Hygiene, oral cancer screening is a critical component of the dental hygiene process of care, and dental hygienists play a crucial role in detecting oral cancer at an early stage. The study found that dental hygienists had a 94% success rate in identifying oral cancer and referred patients for further evaluation.

Furthermore, the National Institute of Dental and Craniofacial Research (NIDCR) states that dental hygienists are qualified to conduct oral cancer screenings and can refer patients for further evaluation if necessary.

Medical billing insurance for Oral Cancer Screenings

Many patients may not realize that their medical insurance may cover the cost of an oral cancer screening performed by a dental professional. This is because oral cancer screenings are considered a preventive service typically covered by medical insurance. However, oral cancer screening costs can vary depending on several factors, including the location, the healthcare provider, and the extent of the examination. According to an American Dental Association (ADA) survey, 77% of dentists bill medical insurance for oral cancer screenings. However, the survey also found that many dentists face challenges navigating the medical billing process, such as understanding medical coding and documentation requirements.

Steps for billing medical insurance for Oral Cancer Screenings

Some steps are involved in billing medical insurance for oral cancer screenings and the codes used for reimbursement

Step 1: Verification of insurance coverage

The first step in billing medical insurance for oral cancer screenings is to verify the patient’s insurance coverage. The dental office should confirm with the patient’s insurance provider if the medical insurance policy covers the screening.

If the screening is covered, the dental office can proceed with the billing process. If not, the patient will be responsible for the cost of the screening.

Step 2: Adequate documentation

Proper documentation is essential for accurate billing and reimbursement. Documentation should include the reason for the screening, the screening results, and any recommended follow-up care.

Step 3: Dental coding

Once the patient’s insurance coverage is confirmed, the dental office must assign the appropriate dental coding for the oral cancer screening. To bill for an oral cancer screening, the medical provider typically uses a specific set of codes, such as CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) codes. The particular codes used may vary depending on the type of screening performed and the insurance provider.

There are several codes used for oral cancer screenings, including:

  1. D0431 – Oral Cancer Screening: This code is used for a comprehensive oral cancer screening.
  2. D7286 – Leukoplakia Screening: This code identifies abnormal patches in the mouth that may indicate a higher risk of oral cancer.
  3. D0191 – Screening for a Suspected Disease or Condition: This code is used for screening when there is a specific reason to suspect the patient has oral cancer.

The dental office must accurately assign the appropriate code based on the type of screening performed.

Step 4: Medical coding

After assigning the appropriate dental code, the dental office must also assign a medical code. The medical code is used to identify the reason for the screening and helps the insurance provider determine the medical necessity of the screening.

What is the medical code for oral cancer screening?

The medical code typically used for oral cancer screenings is Z12.81 – Encounter for screening for malignant neoplasm of the oral cavity. This code indicates that the patient receives an oral cancer screening as part of their preventive healthcare.

Step 5: Billing insurance

Once the appropriate dental and medical codes are assigned, the dental office can bill the patient’s insurance provider for the screening. The billing process may differ depending on the insurance provider and the dental office’s billing procedures.

The dental office must include all necessary information in the billing claim, including the patient’s personal information, the date of service, the dental and medical codes assigned, and the cost of the screening.

Step 6: Payment and Follow-Up

After submitting the claim to the insurance provider, the dental office will receive payment for the oral cancer screening. The payment amount may vary depending on the insurance policy and the dental office’s contract with the insurance provider.

If the claim is denied, the dental office must follow up with the insurance provider to determine the reason for the denial and correct any errors or omissions in the billing claim.

Streamline your Oral Cancer Screenings billing with MedsDental billing company

If you are looking for a reliable and efficient medical billing company specializing in dental practices, look no further than MedsDental Dental Billing Company . With our team of experienced professionals and cutting-edge technology, we can help streamline your billing process and ensure that you receive timely and accurate payments for your services by sticking to HIPAA rules. Our expertise in oral cancer screenings in dentistry medical billing means that we can assist you in navigating the complexities of insurance coverage and reimbursement for these important screenings. With MedsDental Billing Company on your side, you can focus on providing quality patient care while we take care of the administrative work. Contact us today to learn how we can help your dental practice thrive.

Don't wait, Get started with MedsDental today

Let's Connect