#AskT-Bone – Ep27 – Medical Billing for CBCT

Hello and welcome back to another episode of #AskT-Bone on the T-bone speaks podcast! I want to thank each of you for listening and today I’d like to begin by inviting you to join my email list. There’s so much more content that I put out that is beyond the podcast and so much content that I put out in the past that is available through my email newsletter. So if you take the opportunity to simply text the word TBONE SPEAKS to the cellphone number 44222, you’ll be automatically entered into my email list and receive future  exclusive content and other content directly to your inbox. I would greatly appreciate that. So why don’t you take a moment to do that right now? I’ll hit pause and that way you guys can go ahead and text TBONE SPEAKS to 44222.

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Today we have been submitted a question from Simon, and his question is

In your most recent podcast you mentioned the possibility of billing medical insurance for CBCT. I’m on the verge of buying a CBCT and would love to know more about how to file medical form. What code do you use? How long does reimbursement usually take? Are toothaches a medically necessary reason for taking the scan? Any other info on this topic that you think is important would be appreciated. Thanks.


So, Simon thank you for submitting the question, so let’s talk about that. The truth is, I hope that we don’t expect to learn medical billing for dental over a podcast or over a ten minute podcast certainly, but let me kind of go through some things here. In the recent episode I believe, if I remember correctly it’s Episode 7, “Medical billing: what you missing if you’re not doing it”, Chuck and I interviewed Hootan Shahidi. So, I would certainly encourage you, if you have not listened to that, to go ahead and listen to that episode. And we dive into a little bit deeper on terms of what can be medical bill and things like that. I’m not going to lie to you and tell you that if you listen to that podcast you are ready to do medical bill. There’s so much involved in it but I want to answer the questions that you have, so let’s start with this: What are some of the things that we are medical billing for in our practice? This is not an exhaustive list because I’m certainly not billing medical for as many things as I would like to billing medical for or for as many things that is possible. I pick and choose the low-hanging fruit to be quite honest with you, those things that are pretty common in our practice and those things that are relatively easy for us to handle. So exams, radiographs, specifically 3D radiographs. We are billing for sleep apnea appliances, occlusal appliances, occlusal Orthotics and guards, TMD appliances. We are billing for bone grafting, implant failures and implant removal, trauma cases, perio cases when there is medical necessity. So those the pretty most basic things that we’re billing for on the medical. Now what code do we use? To be completely honest with you I don’t have the codes memorized, but all you have do is go on the Google and do a search for “dental to medical cross coding” and a medicare website will pop up and it will give you a download with all the dental codes converted into medical codes. So actually what I’ll do for you guys: we will put a link to the “converting the dental to medical codes”. I’ll just put that link in our show notes so that you can get that and all you have do is visit the podcast page and you can get that there. So that way you don’t have to go searching for it, we will make it available for you. So that is to kind of give you an idea that what codes. So in terms of the code specifically for CBCT there are two codes. One is going to be for the actual scan itself and the other code is going to be for the interpretation of the scan. That does not mean you have to have a radiologist read. Professionally read the scan, that is for the interpretation of the scan by the dentist. So those are the 2 codes that will use for the CBCT. Now, if you take a closer look in the coding book, there will be different CBCT codes based on the volume size that is there. So here are the exact codes that were using: For the 3D scan itself is 70486, for the 3D interpretation is 76376. So those are the codes that were using for the CBCT itself.


How long does reimbursement usually take?

Unlike dental which is pretty straightforward, medical can take a little bit longer, so maybe up to 60 days is what I would say you should expect for reimbursement. Now, when you talk about reimbursement, what I would also like to mention is that we are finding in our practice that CBCT is a payable procedure but is paid in our practice about 15 to 20 percent of the time. In other words, you have to truly find medical necessity for that, and that’s where the ICD-10 diagnosis codes come in, and that’s where when you review your volume, which you should be doing anyway, finding the medical necessity and the reasons that you took the CBCT. So if you don’t have a reason to take the CBCT and you just took it because that’s part of your practice protocol, which I have no problem with, then don’t expect medical insurance to pay for it unless there’s a reason, a medical diagnosis that goes along with it. So do understand that. Are toothaches a medically necessary reason to take the scan? Not exactly. Toothaches aren’t, but some toothache reveal a medical reason. For example if you have a toothache on tooth number three for example, and it has sinus involvement, there could be significant sinus issues there, and that can often provide you with a medical necessity that can justified the scan. Ultimately it is up to the medical insurance or the medical care and the plan provisions whether or not they are going to allow that claim to be a payable claim. So hopefully that kind of understand.

So, now the other question was about another topic on this. Listen, here is what I believe. I believe the cone beam machine is essentially a no cost machine because it’s quite easy to get reimbursed through medical for exams and x-rays and the diagnosis that you find with it and the implant and the sleep apnea the TMD work, there is so much that you can do with this that it’s a no-brainer. So, I encourage you and hope you luck on your journey with CBCT. Certainly I am biased towards to Sirona products, so I hope you buy a Sirona product and then I am biased towards our training on this Sirona products. So we hope to see you at our training programs in the future.
Thank you very much!

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