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Dental bill format for Technical Support

welcome to the dental billing academy podcast powered by ess dental solutions hey welcome to the dental billing academy podcast i am here again with lois banta who we had on one of the very first episodes of the dune bowling academy podcast welcome back lois thank you so much it's a pleasure to be back we're very excited to have you back i knew that you would be a recurring guest so i foresaw this coming and then along with lois we have allison norris who is a hygienist and a consultant as well and what we're going to be talking about today is the d4346 versus d4341 and 4342 so this is a fun coding episode that we're going to be talking about um but we'll start off with allison since we've introduced lois before and will obviously let lois uh introduce herself again for anybody that doesn't know her but allison let's start with you on a little bit of your background and just about you okay great thank you so much for having me amanda um i am a hygienist as amanda said and i graduated in 2007. um i absolutely love hygiene i love being able to provide patients with you know optimal care comprehensive care that they deserve i started working with e-assist in november was when i first got my my assignment and i absolutely love it i love being able to work from home and i stay home with my children it's it's been amazing so thank you great and then lois for anybody that doesn't know who you are which i think is like nobody but just in case tell everybody a little bit about yourself so i am a practice management consultant started i had a company for about 23 years and recently sold my consulting company to e-assist and have become the um chief consulting officer for this amazing company and recruited people like allison to consult practices on the you know improving their bottom line in the business practices and all things involved with running a successful business and maybe uh setting goals to have a little less stress better bottom line and a little less stress i've lectured for many many years i'm still out there lecturing like crazy i love what i do it doesn't feel like work and to be able to share knowledge especially partnering with with people within essence to share the knowledge and the benefits of that knowledge that's a win-win i think definitely and so glad that you recruited allison allison is the one that had the idea for this code-specific podcast wanting to speak specifically about some of the tougher hygiene codes that um dental billers maybe struggle with but then also hygienists may be struggling with so let's start off um alison and lois with with just you all explaining um what is d4346 um so back in the day um 4346 i used to call a profi plus um and so what they did was they developed this code and it's for patients that have um severe to moderate inflammation it's scaling in the presence of severe to moderate or moderate to severe inflammation without connective tissue loss and without bone loss so this food is is great it can be utilized for patients that have gingivitis or pseudo pocketing which is just you know it's essentially just false pocketing so um it can be related to to hormone changes it can be related to medications um and this code is is perfect for patients that have um some inflammation that's beyond just a regular cleaning but isn't yet a you know in need of a scaling and root planning because there isn't any bone loss or connective tissue loss so that's a perfect explanation scaling and replanting in the presence of gingival inflammation it's not full-blown 4341 and 4342 which of course is scaling and replanting for either a full quadrant or a partial quadrant uh 43 46 would be uh maybe the patient needs two appointments so 43 46 would be to remove that that plaque and stuff that's in the way of being able to even do a proper exam and then the second final prophy would you be able to do the fine scale and then follow up with that exam so this like you were saying allison so i remember um and have i remember the very first time this happened but then it has happened several times since then where a hygienist came up and said patience so and so needs to be scheduled for a difficult trophy for an hour and a half or two hours and so essentially is that what you're referring to when you say profi plus so these are those patients um that like you said uh lois that need to have all of that buildup in calculus um may be removed um before the actual profi is is done because you can't do a formal periodontal measurements when you have all that stuff in the way you're not going to get accurate measurements and so and especially when they have inflamed gum tissue like allison was talking about you try to do your perio probing and it's not going to give you an accurate number so you got to remove all that debris first and then the second appointment and you would document that you started an exam but you wouldn't bill out the exam until the second final trophy appointment okay so for any of the clinicians uh listening so that explanation was great and gives a pretty uh pretty clear-cut um separation between the two d4346 and d4341 but for uh dental billers and the clinicians as well because they really need to work as a team in order to get these uh claims sent out cleanly and with the correct information what type of information is needed first off to to determine that it's a 4346 but then to send that claim to get that paid so we want to make sure that you know we have a full comprehensive periodontal evaluation we don't want just numbers you know um and also it's very very important to you know notate the bleeding points and areas where there's some separation which is a very you know nice term of saying pus um or you know you also want to notate any vacation involvement the recession um and then that determines your uh clinical attachment loss um because clinical attachment loss is the um the recession and pocket depths added together you want to make sure that you have diagnostic radiographs that show whether there's bone loss and connect connective tissue loss present um a lot of times for my patients that uh that have perio or whether they are not yet you know to that to that point of having full blown perio we want vertical by wings because you're able to see the tooth better and you're able to see that bone loss a lot better and in addition to that amanda um what i what i would recommend in addition to that is intraoral images so before the procedure commences you can take photographs of the swollen gum tissue and the bleeding points etc and then uh at that second appointment when you've got lots of healing and the gums are not no longer swollen etc a post um appointment intraoral image all of those supporting documentation um methods are gonna help get the claim processed the first time correctly and that's really what we're going through is it's not about utilizing a code to get a procedure covered by insurance it's about supporting the why behind the what and documentation and images whether they're radiographs or intraoral images support the why and that's what insurance reviewers are looking for that's great information and so if there are offices that the dental billers listening right now are thinking well i have never billed that code because the hygienist has never stated that that was the procedure needed or um you know maybe thinking they've told me that there's a tough pro fee and that's what we schedule but now i realize that we could be billing out for the 4346 um there are probably uh hygienists out there that are a little bit um scared maybe of the 40 of 4346 uh or unsure of how to diagnose that and what proper documentation that they need so the explanations that you've given have been fantastic um but for the offices where that is happening how can the dental billers and the front desk and administrative staff really help support the dentist and the hygienist in in that why like you were talking about lois in getting that why for the what to send to the dental insurance i think very very important to have open communication and a team mentality and a dental practice so you know even if it takes having a a you know i'm a big proponent of having full team meetings and everyone being able to give their feedback and you know having that open communication because if one person doesn't understand it and if one person isn't on board then that can kind of upset the whole apple cart if if you know what i'm saying so you want everyone to kind of be on the same page and if the hygienist says you know this patient is a more difficult profi um they need to have you know scaling and presence of inflammation um then then we can explain to them explain to the front desk express you know to the front office to the front staff um what is needed to go along with that and and in turn the you know hygiene team the clinical team needs to also be aware of what is needed so if the radiographs aren't as diagnostic as they should be then they may just have to retake radiographs or if you can't see you know bone level as well then they may have to take that horizontal radiograph that they took that horizontal bitewing that they took and then you know take a vertical bitewing instead um now and that would be in regards to you know for scaling and root planing patients but um you know for them for everyone to be on the same page as key i guess is uh is kind of to sum that up so yeah and in addition to that um sometimes the radiographs being two-dimensional are not going to show the evidence as much as describing it in a detailed narrative or taking an intraoral image that where you may be able to take a a lingual photograph of what's going on in the mouse um any supporting information that's what the s sees can really drive the point home with the dental offices is more is better less is not better so the more you detail it out so if the radiographs don't show the 100 conclusive evidence then you want to make sure that you template a note that you can customize to meet the patient's diagnostic needs and really support it through the through the words on the page so to speak and then in like a triple whammy would be the intraoral image so you want radiographs intraoral image and you want a detailed explanation of why this diagnosis was there also careful explanation in your team meetings about answering those patient questions basic questions going to come up is will my insurance cover that and well that's you know that's the million dollar question because some insurances cover it some don't but it's not why you build a code you build a code because it's the appropriate code for the circumstance surrounding what the patient needs absolutely definitely we don't want insurance to ever dictate the treatment that the patient's getting and then as uh dr shelburne explained in the last episode that while this is a code that has been around for i think two years now yeah is that right yeah well it's been around for two years there may be some insurances that the patients plan it's not listed as a covered code on the plan because their hr department did not uh renew the uh to a newer plan that included any of the new cdt codes and is still operating on the original planned uh covered code so these new codes that are approved by the cmc are not grandfathered in to existing plans the hr department actually has to renew that so do not assume just because the code is two years old it's still fairly new there could be insurance plans that your patients have that it's not a covered benefit um so double check that you know with the insurance so that you can accurately give them that treatment plan um because like lois said we don't want the insurance to to dictate or patients get upset because they were told it would be covered when it's really not a covered benefit always best to explain to the patient that um the design of your plan does not dictate how we diagnose your treatment um we diagnose the dentistry that is in your best interest it may or may not be covered by your plan you may want to check with your hr department and just so um the so everyone knows on this call best way to communicate is that employers dictate what is and isn't included in a dental benefit plan it's not the insurance companies this is one case where they're really not the bad guys that's the employer if they're if they want their premiums to stay low then they exclude a lot of codes that would typically be covered right and if you would like that um what was it uh lois the exact wording the design the design of your plan may may limit what your insurance pays i have actually if anybody wants to order that from me it's free right and i have to find that um you can hang right on your wall that says you know dear patient design of your plan may pay differently in this office yeah or just submit what your insurance pays just email podcast ess dot me and i'll shoot you that over because um yep lois is providing that as a free resource to any dental offices that would like to have it because it is worded beautifully and very helpful yeah i got a lot of stuff in my in my wheelhouse so happy to share that great okay so if the dental biller and the hygienist have um gotten all of this documentation that sent it with the claim for 43.46 or let me back up they've sent it with the all of the necessary information for a claim for d4341 and the insurance downgrades to a d4346 based on the clinical documentation um is that acceptable or if the if 4341 is is denied altogether can the 4346 be asked um to be considered as an alternate benefit i wouldn't typically recommend a 4346 as an alternate benefit i would recommend you fight like heck to get that 4341 and my guess if i were guessing why a claim gets denied it's because that not enough detailed narrative was supplied to support the 4341 diagnosis if you just send x-rays and maybe even the charting but you don't send a detailed narrative attached to that the chances of getting that claim processed as a true 4341 lesson says um i i've said this so many times obnoxious detail wins out every single time the more detailed and the less guessing the insurance reviewer has to do um the better the claim will get processed accurately so in my opinion and i'm sure allison's opinion uh processing of 4341 and down quoting it to a 4346 is an error on the insurance company's part but also an error on the dental office's part that they didn't supply enough detailed information absolutely that's why we have a protocol right right that's why you won absolutely i completely agree i completely agree because you know once like i say once a perio patient always a perio patient so if a perio patient is in is in need of you know 4341 or 4342 that means that they have full blown periodontal disease with bone loss and supported you know connective tissue loss and so we want them to be able to um to to be able to you know be a periodontal maintenance patient so we can see them more frequently and also um you know we want we want the most comprehensive care for our patients and we want um for every one of our patients to have optimal health and the only way of being able to do that is you know filing what needs to be filed and not um not up coding and not down coding from what is actually you know needed for that particular patient and um to add to allison's comment of 4346 is not a precursor to follow-up appointments being 4910 a 4910 is always tied to scaling and rear planning but the 4346 is kind of like its own standalone code follow-up this would either be another 4346 or a 1110 profit it's a precursor to possibly the patient needs scaling number planning right allison yes yes ma'am yeah i'm not the hygienist you are but i'm a coder and i know stuff exactly um we actually have a couple of other people on the call too this is a fun we have some people joining this podcast live um so i would like to ask right now if anybody joining live uh has uh an opinion would like to weigh in with some feedback or maybe has a question for any of the panelists so we have charity um i always feel like i'm gonna say your last name incorrectly charity there we go joining us who is also a hygienist uh and a fantastic dental biller as well um charity you can take you know a few seconds to kind of tell us about your background in dentistry and then jump in with your question feedback opinion whatever you have for us sure thing so yes my name is charity taban i've actually been actively in the dental field still a current hygienist for 20 years now and i joined the assist five years ago so i got to learn even more about the dental billing side which in turn ultimately helped me be a better hygienist so to kind of caveat with both alison and with lois it's really important to have these team meetings that everyone understands how everything works to be able to tell the people up the front what they need from a hygienist and the hygienist can tell them what they're seeing so then that way they can bill appropriately it's going to maximize the oral health of those patients because that's what offices are there for you know how dentists are there for we want to bring everybody to optimum oral health which as we all know in turn is often body health you can tell but we always want to make sure that we are you know bringing the all that to our offices and to our patients thank you so much charity yeah thank you i almost feel like we should call this episode like two hygienists in the lois because we've got it sandwiched perfectly i have such an appreciation for the knowledge base that hygienists bring to the table on the practice management side um and that's why and i'm going to reiterate thirdly that team meetings are they play as such a crucial role in consistency in how we treat our patients and with um what procedures we're offering to our patients when we have a protocol something in writing that when this is exhibiting this is the code we're going to use when this is present this is the code we're going to use and then you can document and template uh detailed narratives that match the treatment plan that you're offering to that patient that is a great marriage and then when you take the administrative team's business talents on the coding and billing to the insurance side now you've got the perfect marriage i absolutely agree great well i always like to ask this every episode and so we'll start with you allison um to give lois a little bit of time to think uh about a different nugget of wisdom than she gave on the first episode of the dental billing academy so um allison what for dental billers out there um and this can be related to what we were talking about or it can be something different but what nugget of wisdom do you have for just all dental billers everywhere moving forward from today on in their workplace guess i would say get as much documentation as possible make sure that what you're documenting is you know what is written in the clinical notes and what is performed by the dentist or the hygienist whoever the provider is you know making sure that uh radiographs are up to date period charting is up to date um and not just in terms of you know for for your hygiene team but as well as you know your doctors making sure that um you know your radiographs that um you're sending for a crown are recent radiographs up-to-date radiographs um making sure that if you are using a note template that you're not just copying pasting the same exact um note and narrative for every patient across the board because sending the insurance company um you know the narrative recurrent decay um you know a regular margin for a crown um eventually the the insurance company may end up getting flagged you know that that they or the doctor's office may end up getting flagged by that by the uh insurance company and so you just want to make sure that whatever you're submitting is as up-to-date and accurate and you know as detailed as possible and my negative information to add to what allison said um what i want what i want teams to remember is that systems are the crucial element that will it's the glue that holds everything together communication is the cherry on top of the sundae so how you say what you say matters but how you detail it out also matters and what allison was saying in making sure you just don't have a canned narrative insurance companies recognize that they will pick the claim out and most likely put a practice on focus review is if if the narrative is is too generic so template your narrative but create an opportunity to customize each one of those narratives for the patient's experience for the patient's diagnosis and treatment plan and that's what i'm talking about in a systematic approach you've got to have a systematic approach to everything your team meetings your morning huddles your documentation processes and then your communication between your outsourced um company like easy and the dental practice that has to marry very well together and that's where the communication cherry on top of the sunday aspect comes into play we want the dental practices to be successful the demo practices want their claims paid in order to do that we have to talk well with each other we have to play nice in the sandbox with each other that's my nugget thank you so much those are both great nuggets and i appreciate you both um joining me for this podcast episode this was tremendously helpful uh for anyone that has any questions for either lois or allison regarding what we talked about today you can email me at podcast assist.me or if what we were talking about got very very um confusing because of all the codes we were throwing around i will actually be more than happy to provide you a very simple explanation of the different codes and what alison and lois both went over that you can hang up at your front desk or put next to your computer that will help you to remember what's needed with a 4346 when it's not okay for it to be an alternate benefit and things like that um as it as always if you would like to follow us on facebook or instagram just search dental billing academy and then if you would like to join one of these podcasts live and jump in and talk with the panelists like charity did then just email me again podcast ess dot me and we'll get you invited to the next podcast episode because it's a lot of fun it is always a pleasure thank you so much thank you click subscribe now to never miss an episode and find us on facebook to expand your network