Billing Exams, Wisdom Teeth and TMD/Sleep Apnea Appliances to Medical Plans — Basic Course

Jul 11, 2014

Many dentists are under the misconception, for various reasons, that medical plan benefits can only be accessed in cases involving trauma, but this cannot be further from the truth. Current medical plans on the market cover a wide variety of procedures ranging from simple examinations and consultations, such as oral cancer screenings and exams for minor issues like herpetic lesions, aphthous lesions, tori, Candidiasis and dry mouth, to the more complex, such as atrophy of the alveolar bone and pneumatization (enlargement) of the sinus as a result of tooth loss. In addition, both surgical and nonsurgical treatments for these and a myriad of other infectious, inflammatory and pathological problems are medically covered, including therapeutic (topical) treatments; periodontal surgical services; Stage I and II implant treatment; TMD, orthodontic and sleep apnea appliances; and oral and dental procedures related to traumatic injury.

This one-day presentation is an introduction to the basics of medical billing and will discuss the different medical plans on the market, the basics of medical diagnosis and procedure coding, as well as medical documentation requirements. Claim examples for examinations, consultations, radiographs, wisdom tooth extractions, and TMD and sleep apnea appliance therapies commonly performed in the dental office will be presented and discussed.

Course Objectives Part I: Lecture

(a) Medical Insurance Overview: Medical plans and what they cover Patient history and clinical notes for medical billing (b) Medical Coding and Guidelines: ICD-9 (Diagnosis) Coding/CPT (Procedure) Coding Documentation requirements and correct formatting for medical billing Part II: Medical Coding – Practical Applications

Claims Preparation: The CMS-1500 (08/05) Medical Claim Form and claim examples

Procedures covered include:

+Examinations, diagnostics

+Therapeutic treatments, including TMJ and sleep apnea

+Wisdom teeth

+Upon completion, participants will be familiar with:

+Medical diagnosis and procedure coding and rules for claim submission

+The correct completion of the CMS 08/05 Medical Claim Form

+Documentation required to support medical necessity for the procedures presented

NOTE: CAN BE COMBINED WITH “Medical Billing for the Comprehensive Dental and Surgical Practice – Advanced Course” on March 8, July 12 and Oct. 18, 2014.



Olya Zahrebelny
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