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Medical billing for dental offices is more challenging than it seems, primarily because it differs from medical billing. Standard dental procedures get billed to dental insurance companies, but only with an intricate process. 

However, certain dental services – such as sleep dentistry – fall under the domain of medical insurance. Such differences make the functioning of dental insurance companies quite different from medical insurance companies. 

CDT Codes for Dental Coding and Billing 

Medical billing for dentists is based on CDT codes that differ for different dental procedures. These codes are considered for different dental services, such as in the following:

  • Orthodontics 
  • Preventive 
  • Adjunctive General Services 
  • Diagnostic 
  • Fixed Prosthodontics 
  • Periodontics 
  • Oral and Maxillofacial Surgery 
  • Restorative
  • Implant Services 
  • Endodontics 
  • Maxillofacial prosthetics 

Identifying the differences between CDT codes and determining their correct usage for accurate dental billing is essential. Their usage may differ depending upon a patient’s insurance since the insurance provider would cover their dental expenses.

Notwithstanding the nature of the dental claims and whether or not the electronic transactions are HIPAA compliant, CDT codes are used to bill services in dental coding procedures. 

The federal government regulates the present dental technologies for their utilization in dental services billing as a national terminology to government-assigned insurance companies. Additionally, the CDT codes are crucial to designate procedures and are used as a communication standard throughout the multiple dental services departments. 

How do Dental Practices Bill Through CDT Codes? 

Dental insurance is necessary for the use of CDT codes for dental coding and claiming billing reimbursements. An insurance provider will refuse to pay a patient’s dental claims if their health insurance does not cover dental insurance, even if it includes medical insurance. 

Most patients think their medical insurance would also cover their dental claims, which is not the case. Dental practitioners generally keep a close eye on patients’ insurance coverage since particular dental procedures are undertaken primarily through the patient’s medical condition. 

This way, patients can claim reimbursement from insurance companies, convincing them of the need for further treatment. However, insurance companies generally do not reimburse claims for the services they do not cover, even if they are billed using standard CDT codes.

How are CDT Codes for Claim Submission Processed?

The forms for claims under dental procedures where both dental and medical coding can be used are different. These different claim forms are designed mainly for their concerned practices, with the required information including:

  • Procedure description 
  • Tooth system 
  • Tooth surface 
  • Missing teeth information 
  • Tooth number or letters 

This information is included with the dental forms, along with any other necessary information particular to the procedure, such as any special treatment performed. 

Billing Medical Insurance for Dental Treatment 

As discussed, dental and medical claims are quite different. Medical claims are submitted on the CMS 1500 form, whereas dental claims are billed on an ADA 2019 form.

Additionally, a dental claim uses CDT codes, whereas a medical claim works on CPT codes. Although these two codes can be cross-coded, it is usually an intricate and arduous task.

Let us look at a few instances where you can file medical insurance for your dental claims:

  • Trauma – including broken teeth and broken jaw. 
  • Oral Surgery 
  • Obstructive Sleep Apnea 
  • Pathology – in case a dentist needs to perform biopsies to check for diseases inside the gums, teeth, or around the mouth. 

Determining when to file medical and dental claims can prove quite confusing. Thus, a good option is to call your medical and dental insurance companies to confirm the billing process. 

How to Master Your Dental Billing

Dental billing can be arduous to master, primarily because it requires expert knowledge of medicare rules, coordination of benefits rules, appealing denied claims, calculating and entering write-offs, attaching necessary documentation for particular procedures, the latest coding updates, and much more. 

However, you can keep up with your dental billing through the following tips:

  1. Keep your dental billing process streamlined and cover each billing-related task systematically, from scheduling payments to posting. A seamless dental billing process is the best way to maintain financial health. 
  2. Control your expenses by managing insurance claims processing. Although certain factors, including insurance policy changes, state regulations, federal regulations, patient information, and CDT coding changes, are out of your control, you can keep a keen eye on codes and regulations, denials, claims, and policy updates to stay on top. 
  3. Continue learning since regulations, insurance policies, and medicine continue to metamorphose and evolve, making an investment in training and education a beneficial endeavor. 

SmartClinix can provide expert dental billing services while lowering your dental rate, skipping AR delays, and increasing your revenue. SmartClinix’s team offers smart medical billing services for enhanced cash flow, efficient revenue cycle management, and seamless claim submissions.

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