Most Frequently Asked Coding/Claims Questions The AAO Dental Benefits Advisory Service (DBAS) Hotline provides assistance to over 300 callers per year. DBAS staff provides help with issues such as practice management situations, resolution of claims issues with payers and help with medical and dental coding questions. In recent years, almost half of the DBAS calls now focus on dental coding issues. Answers to the most commonly asked coding and claims questions have been compiled as a resource for your practice. Q: How should our office code for more than one stage of orthodontic treatment?
A: In most cases, the most effective way to code for multiple phases of orthodontic treatment is use of Limited coding for the initial phase and Comprehensive coding for the subsequent phase. For example: if you have a juvenile patient that will require a rapid palatal expander (RPE) prior to full, active treatment, we recommend that you code the claim for the RPE as D8010 or D8020-Limited orthodontic treatment of the primary (D8010) or transitional dentition (D8020). When the more complex phase of treatment begins, an appropriate code to use would be D8080-Comprehensive orthodontic treatment of the adolescent dentition.
Q: Some dental insurance carriers/payers will not pay for more than one stage of
comprehensive treatment? Why?
A: In order to offer employers a way to save money on their employee dental benefit programs, several insurance payers have begun to “carve out” payment of this benefit from contracts they have with the employers. This has begun to be a popular option for employers…..they are able to continue to offer orthodontic benefits to their employees, but with the additional phase of treatment being excluded from payment, annual premiums are reduced.
Q: Our office is confused on when to use transitional, adolescent or adult coding. Please
explain when to use each code.
A: Generally speaking, your office would use “transitional” coding for patients that exhibit a mixture of deciduous and permanent dentition; “adolescent” coding would be used for patients approximately 12-13 years old that have shed all their primary teeth; “adult” coding would be used for those patients who are approximately 18 years of age and may or may not have third molars (wisdom teeth) erupting or in place.
Q: What code would our office use for delivering a retainer?
A: If a patient has just completed active treatment and had their braces stripped,
the code to use would be D8680-Orthodontic retention (removal of appliances,
construction and placement of retainer(s). If your patient is a few months out of
active treatment but has lost their retainer, the code “D8692-Replacement of lost or
broken retainer would be used. Finally, if a patient who is several years out of
treatmentpresents (perhaps their teeth have shifted, etc.) we would recommend use
of Limited Orthodontic treatment coding. You would simply use the code that best
describes their stage of dental development. For example, if your patient is an adult,
delivered to the patient. Q: How do you handle professional or family discounts when submitting claims?
A: When offering discounts to patients you must disclose the discount to payers. The
recommended way to submit the information is via the claim form. On the initial claim
form, simply list your fee, note the discount and subtract that amount from the total fee
charged. If, for some reason, over the course of treatment you decide to write off a patient balance, you will need to notify the insurance carrier as well.
Q: How is the best way to submit an initial claim for treatment?
A: When submitting the initial claim for treatment, it is a good idea to establish exactly how
your office expects the case to be handled financially. On the claim form, be sure to include
the following components:
Appropriate CDT code
Total treatment fee
Subtract down payment and/or discounts, if any
Indicate the months of expected treatment and indicate payment amount and mode (monthly, quarterly, etc.); most offices pro-rate the remaining balance after down payment over the months of treatment
Q: How is the best way for our office to handle a case in which a child’s parents are divorced?
A: Our recommendation is to consider the parent who presents the child for treatment as the “responsible party”. Execute the treatment contract with that parent and make them your “point person” for the case, trying to deal with them exclusively. It is very important to remain neutral in the event of any acrimony or disagreements between the parents. Your office must keep yourselves out of the middle of any issue that may arise.
The AAO sponsors the DBAS Hotline as a member service for you and your staff. We are happy to help in any way possible. The Hotline is available from 8:00 AM to 5:00 PM Monday through Friday and can be reached by calling (800) 424-2841 X582 or by email at firstname.lastname@example.org.