Medical billing for dentists is no different from any other billing process. However, since billers are more familiar with hospitals where dentists mostly aren’t present, they are afraid to provide their services to a dental clinic. They think this is something different and they have to learn dental billing as a proper course.
But let us clear up your confusion that there is not any difference between dentist and clinic billing. The procedure is completely the same. However, some codes are different and so is the documentation.
So here you are going to learn how to perform medical billing for dentists successfully without investing your time in wasteful courses.
Basics Of Medical Billing For Dentists
Medical billing is an intricate process of preparing bills for patients on behalf of their services received, which also includes code identification. So when we talk about dental billing, this is the same procedure as we mentioned but here the service provider is a dentist.
One big difference between billing for a medical clinic and a dental one is that since a dentist uses different equipment than a physician, codes associated with the equipment will be changed too. Also, the services rendered are only limited to teeth and mouth, so here coding will only include limited codes describing dental services and equipment only.
To make you understand medical billing for dentists further, here we have mentioned some basic terms used in the process so that you can know what dental billing is:
CPT Codes
These are a set of predefined codes associated with each dental service and supplies used. When creating a bill, based on the patient’s treatment, these codes are mentioned so that a patient or their insurance payer can pay for it.
Claim
Same as in typical medical billing, a claim is an application that lists all the charges billed for the patient. This is then sent to the insurance company on behalf of a patient so that they can make the reimbursement.
Explanation Of Benefits (EOB)
EOB is a document that an insurance company sends to the patient. It contains all the information about what they have paid, what they have discounted, and the patient’s responsibilities like deductibles and copayments.
Deductible And Co-Payment
Even after some of the bill is paid by the insurance companies, a patient owes some amount. This is called deductible (out-of-pocket cost of the service) and co-payments (fixed amount paid due at the time of visit).
Key Steps In Dental Billing
Now that you know some essential terminology used during medical billing for dentists, let’s dive into the steps this process involves and what tasks are done in each.
Patient Eligibility Verification
When first patients visit the dentist, their information is collected. During this process, their insurance eligibility is also verified to start the further process. This step ensures the patient is eligible for the services and thus they are welcomed in the hospital or clinic.
Documentation
Then, after the completion of dental services, a detailed document is prepared in which the total diagnosis, treatment, dental supplies, and other relevant information are mentioned. This documentation runs throughout the treatment duration because more supplies or dentist’s recommendations might be added later.
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Coding
Here based on the patient documentation, you will translate each medical service into a code and create a bill. Most clinics have a separate medical coder for specifically this work. But if you are hired as a both, you will have to identify codes and mention them in the claim application.
Claim Generation
Now after code assignment, a claim application is generated mentioning all the necessary details insurance companies ask for. This is the most crucial step since it decides whether your hospital or clinic is going to receive the payment or is your claim going to be rejected.
Claim Submission
The claim you generated in the previous step is now going to the insurance payer. They will examine it carefully. Verification involves checking services given to the patient, accurate codes and charges, patient insurance plan, and asked documents along with the claim application. After thoroughly inspecting the claim, they will make the reimbursement.
Follow-up
This is another crucial step of medical billing for dentists that is often overlooked. As a medical biller, it is your responsibility to keep an eye on all the claims you submit. This way you will be able to analyze what claims are paid and which are yet to pay. So that you can send reminders to the payers or even resolve any issue if rejected. It helps in managing the dental clinic’s finances.
Bill Collection
In the end, when you receive reimbursement from the insurance payers, as we mentioned, there is some amount that a patient has to pay, and you have to follow up with them. This step ensures patients are aware of their owed bills and they are paid on time.
Sometimes many patients can’t pay the bill due to their weak financial conditions, so you will have to offer them a payment plan, mostly based on installments. This way they will be able to pay the bill, no matter gradually within a specific period of time.
Dental Billing Codes
The entire medical billing process is similar to normal coding. But as we discussed earlier, here the difference is among the codes. There are certain codes that are used only during medical billing for dentists. They can’t be used in the typical billing process so this makes it unique. Here are mentioned some of the codes that are utilized during dental billing.
CDT Codes (Current Dental Terminology)
The American Dental Association (ADA) is responsible for maintaining CDT codes, which are unique to dental procedures. They offer a uniform method for coding and recording dental services. Some instances are:
D0120 – Periodic oral evaluation
D4341 – Periodontal scaling and root planing, four or more teeth per quadrant
D7140 – Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth
Dental Diagnosis Codes (ICD-10)
ICD-10 codes are crucial for dental billing because they indicate the medical necessity of specific procedures, even though they are mainly used for medical diagnoses. For example:
K02.1 – Caries of dentin
K04.6 – Periapical abscess without sinus
CPT Codes (Current Procedural Terminology)
Although CPT codes are more frequently linked to medical procedures, they can also be used in dental billing, particularly in cases where dental procedures are necessary for medical reasons. Some instances are:
41899 – Unlisted procedure, dentoalveolar structures
21248 – Reconstruction of mandibular rami, horizontal and/or vertical alveolar bone, autogenous graft (includes obtaining graft)
HCPCS Level II Codes
For goods, supplies, and services that are not covered by CPT codes, Level II codes for the Healthcare Common Procedure Coding System (HCPCS) are generally utilized. The following dental supplies may have HCPCS codes:
D2970 – Temporary crown (fractured tooth)
D2999 – Unspecified restorative procedure, by report
SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms)
A comprehensive system of clinical terminology that is used globally is called SNOMED CT. It offers codes for expressions and terms used in clinical dentistry. For instance:
431311000124102 – Dental caries of enamel
70784009 – Fracture of tooth (SNOMED CT concepts)
From Medic To Medic-Dent
Though medical billing for dentists is not complicated, this procedure might differ in some steps. But overall you have to follow the steps we mentioned that are no different than normal medical billing.
So if you want to switch to dental billing, you don’t need to learn billing from the start. Instead, just pay attention to the new codes used for dentists and you are all set to step in your career.