Wiki Coding E & M For Dentists And Separate Code For Screenings Ordered By DDS/DMD

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WeisMed2015

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So, as far as I know there is NO certification program for DENTAL procedure coding to MEDICAL insurance plans. I've been a dental practice management consultant for 17 years now and in the past few years have tackled billing certain services to patients' medical plans. I'm having success, but BCBS has been quite frustrating. After a 2+ hour call with BCBS rep today, I decided I needed INDUSTRY SUPPORT!

If a patient comes to a HEALTHCARE PROFESSIONAL with a chief complaint of oral/facial pain - and definitive diagnoses are obtained as a result of examination....THEN, the doctor orders a screening "while the patient is there" that is NOT tied to the patient's chief complaint, but rather INSPIRED by the clinical findings during examination.... How do I code that? Is there a modifier that I use on the screening procedure code?

Also, I learned a hard lesson with BCBS today that using (2015) V82.89 on my screening code makes the code come up as ROUTINE and, therefore, the claimed service is DENIED because the plan does not cover "routine" procedures... The screening is NOT routine... it was ordered by the DDS/DMD based on clinical exam... is there a "non-routine" screening code/modifier someone can point out to me so that patients obtain the reimbursements they are entitled to when DENTAL goes to MEDICAL.... AND if there IS a DENTAL/MEDICAL certification program, point me in the direction of IT, too? Thanks!!
 
V82.89 is extremely vague so i'm not surprised they don't want to pay. What kind of screening was it? Why was the screening needed. If no definitive DX, a symptom code could still be used. Screening usually means asymptomatic and would typically be considered routine.
 
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Screening For Caries Risk

The DDS/DMDs that I work with are doing more than charting the dental defect/condition... they are beginning to delve into the WHY... old days: you need 4 fillings and a crown... where we are trying to get to: your medication has a known side effect of dry mouth. that side effect has resulted in damage to your teeth. the "caries risk assessment/screening" completed today indicates your lifestyle and/or habits is contributory to the conditions I've seen during today's examination....

Often, I code a 99212 with a V70.0 as one of the codes...but was told by BCBS today that because that code is identified as a ROUTINE examination, the examination is not a covered service under some plans...
For Caries Risk Assessment/Screening, I code a 41899 - attach the screening documents and all clinical notes - with aV82.89 Special screening for other specified conditions....

I was told that the ROUTINE exam code did not establish MEDICAL necessity....
I was told that the Special Screening was determined as INCLUSIVE to the ROUTINE DENTAL EXAM...

Now, I've been paid by BCBS for 99212 + 41899 before... I want to find coding that eliminates the gray area that BCBS seems to like to find in claims!! HELP?!???
 
That is not something that is covered by any medical carrier I've worked for. That's more of a dental issue since it deals with the teeth.
 
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