Tips for successful oral surgery billing

Tips for successful oral surgery billing

Oral surgery is complex and requires specialized knowledge, skills, and equipment. Therefore, it is essential to ensure that the billing process for oral surgery is carried out accurately, efficiently, and in compliance with applicable laws and regulations. Proper billing for oral surgery ensures that healthcare providers receive fair compensation for their services and plays a vital role in maintaining patient satisfaction and trust. For this purpose, dental organizations need professionals and experts to lead every step flawlessly. This article will share some essential tips for successful oral surgery billing, including navigating the complex coding and documentation requirements. With these tips, healthcare providers can optimize billing processes, streamline operations, and provide exceptional patient care.

6 rules to remember for successful oral surgery billing

Insurance verification must be on priority

Insurance verification confirms the details of a patient’s insurance coverage, including eligibility, benefits, and co-payments. It is a vital step in the billing process as it ensures that the surgeon is reimbursed for their services and that the patient is not burdened with unnecessary financial strain.

Verifying insurance is particularly important in oral surgery, where procedures can be expensive and often require multiple appointments. Failure to verify insurance can lead to denied claims, delayed payments, and unexpected costs for the patient and the surgeon.

Steps for Successful Insurance Verification

To ensure successful insurance verification, oral surgeons must follow a series of steps:

Collect patient Information: Collecting the patient’s insurance information is the first step in the verification process. This information includes:

  • Name
  • Phone Number
  • Address
  • Email Address
  • Contract Preferences
  • Date of Birth
  • Name of the subscriber’s employer or insurance plan
  • Insurance carrier
  • Carrier’s provider phone number
  • Insurance ID number

Contact Insurance Carrier: Once the patient’s information is collected, the surgeon or billing team must contact the insurance carrier to verify coverage. This can be done over the phone, through an online portal, or via email.

Verify Eligibility: The next step is verifying the patient’s coverage eligibility which includes confirming the policy is active, the patient’s coverage start date, and any exclusions or limitations.

Check Benefits: After verifying eligibility, the surgeon must check the patient’s benefits to determine the level of coverage for the procedure. This includes understanding the deductible, co-payments, and any out-of-pocket expenses.

Confirm Prior Authorization: Certain procedures require prior authorization from the insurance carrier before the surgeon can perform them. It is essential to confirm whether the procedure requires prior authorization and, if so, to obtain it before the surgery.

Document Everything: It is essential to document all interactions with the insurance carrier, including the date, time, and name of the representative spoken to, as well as the conversation’s outcome.

Use the appropriate medical and dental codes and provide all necessary documentation

Using the correct codes for oral surgery billing is critical for several reasons.

  • Firstly, it ensures that dental practitioner is appropriately compensated for their work.
  • Secondly, it allows insurance companies to accurately determine the cost of the procedure and, consequently, the amount of reimbursement to which the patient is entitled.
  • Additionally, using the appropriate codes ensures that the patient’s medical records are correctly documented, which is essential for future reference and follow-up treatments.

When it comes to oral surgery billing, there are several codes that dental practitioners need to be familiar with. The most commonly used codes are the CPT codes and the ICD codes.

CPT codes:

For oral surgery billing, some of the most common CPT codes include:

  • 41870 – Surgical removal of an erupted tooth requiring elevation of a mucoperiosteal flap and removal of bone or section of a tooth
  • 41899 – Unlisted procedure, dentoalveolar structures
  • 42600 – Excision of lesion of oral soft tissue (e.g., cyst, granuloma, fibroma)
  • 42700 – Excision of benign tumor or cyst of jaw or oral cavity
ICD codes:

For oral surgery billing, some of the most common ICD codes include:

  • 8 – Other specified disorders of teeth and supporting structures
  • 2 – Atrophy of edentulous alveolar ridge
  • 2 – Cellulitis and abscess of mouth
CDT codes:

In addition to CPT and ICD codes, dental practitioners should also be familiar with CDT codes, some of which are:

  • D7140 – Extraction, erupted tooth or exposed root (elevation and forceps removal)
  • D7210 – Extraction, surgical, erupted tooth requiring elevation of a mucoperiosteal flap and removal of bone or section of a tooth
  • D7250 – Surgical removal of residual tooth roots (cutting procedure)

To ensure successful billing, supporting documentation must be provided to the insurance company or payer. This documentation should include the following:

  1. A detailed description of the procedure performed, including any complications or unexpected findings
  2. A description of the medical necessity for the procedure, including any symptoms or conditions that led to the need for surgery
  3. A copy of the patient’s medical record, including any relevant medical history or prior treatments
  4. A consent form is necessary to document the patient’s informed consent for the oral surgery procedure.
  5. Radiographs should be included in the patient’s medical record and submitted with the billing claim.

Don’t over-code on your insurance claim

Over-coding occurs when a dentist submits a claim for a service that is more expensive or complex than the service performed.

For example:

  • If a patient received a simple tooth extraction, but the dentist billed the insurance company for a surgical extraction, that would be considered over-coding.
  • Sedation time is when the patient is anesthetic; this time is recorded and billed to insurers for reimbursement. If you use Nitrous oxide with local anesthesia, you cannot code or bill the sedation time separately for both anesthetics.

If you over-code or over-bill any service, it would be considered fraud, and you must face a penalty.

Always bill medical insurance first for any pathology-related procedures

Assisting your patients in optimizing their dental and medical benefits can serve as a valuable means of establishing a strong rapport between them and your dental practice. It can also cultivate a sense of confidence in the abilities of your clinical and administrative teams. For this purpose, pathology-related services are the first bill to medical insurance.

Pathology-related procedures refer to any oral surgery related to a medical condition. This could include surgery to remove a tumor, repair a cleft palate, or treat a sleep disorder. There are several reasons why this is a best practice.

  1. Firstly, medical insurance is generally more comprehensive than dental insurance. Medical insurance is designed to cover a wide range of medical procedures, including oral surgery, and often has higher coverage limits than dental insurance.
  2. In most cases, oral surgery procedures fall under medical insurance. For example, a procedure like dental implant placement may be considered cosmetic or elective by dental insurance, but medical insurance may cover it if it’s necessary due to a medical condition.
  3. Another reason to always bill medical insurance first for pathology-related procedures is that it can help to reduce patient out-of-pocket costs.

Upon receipt of the Explanation of Benefits (EOB) from the medical insurer, it is incumbent upon your practice to cross-code the medical Current Procedural Terminology code to a corresponding dental Current Dental Terminology code. This requires understanding the nuances of both coding systems and a deft touch in navigating the intricacies of the medical and dental insurance realms.

Stay up to Date on Industry Changes

Oral surgery billing involves submitting claims to insurance companies, which can be complex and ever-changing. It is vital to keep up with the latest changes in insurance policies, billing codes, and regulations to ensure accurate and timely reimbursement for services rendered.

To stay up to date:

  • Oral surgery billing professionals should attend industry conferences, read industry publications, and participate in continuing education courses.
  • Additionally, they should regularly review insurance policies and coding guidelines to ensure they use the most current information when submitting claims.

Outsource billing work

Benefits of outsourcing billing work

  • Allows oral surgeons and their staff to focus on patient care and other aspects of the practice rather than spending time on billing and administrative tasks.
  • Can potentially lead to faster and more accurate billing, as professional billing companies or individuals may have more specialized expertise and tools to handle the job.
  • May save the practice money in the long run, as outsourcing can help avoid costly mistakes or missed billing opportunities.

Considerations when outsourcing billing work

  • It’s essential to carefully vet any billing service or individual before hiring them to ensure they have the necessary skills, experience, and reputation for handling the practice’s billing needs.
  • Communication between the billing service/individual and the oral surgery practice is crucial to ensure that billing information is accurate and up-to-date.

Unlock the Secrets to Successful Oral Surgery Billing with MedsDental

Looking for a reliable partner to handle your oral surgery billing needs? Look no further than MedsDental Dental Billing Company! Our team of experienced professionals is dedicated to helping you maximize revenue and streamline your billing process. With our advanced technology and in-depth industry knowledge, we can help you easily navigate the complex world of dental billing and increase your reimbursement. From verifying insurance coverage to submitting claims and following up on payments, we’ve covered you at every step. With MedsDental on your side, you can focus on providing the best possible care to your patients while we take care of the rest.

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