Medical Coding For Alveoloplasty With Extractions For A Dental Billing Company

Medical Coding For Alveoloplasty With Extractions For A Dental Billing Company

Alveoloplasty is a common dental procedure done to reshape and smoothen out the jaw where a tooth or teeth have been extracted or lost. It can be done in conjunction with tooth extraction or after healing. Dentists can rely on experienced dental billing companies to report diagnoses and procedures performed correctly in dental claims.

Alveoloplasty reshapes and contours the jawbone’s natural structure that may have been lost due to bone loss from tooth extraction or other reasons. It can speed up the healing process and reduce blood loss after extraction of multiple teeth. In most cases, the procedure is typically performed in office during the extraction procedure.

According to the American Association of Oral and Maxillofacial Surgeons (AAOMS), alveoloplasty with extractions is recommended in conjunction with multiple extractions for irregular alveolus with sharp bony projections, for pre-prosthetic bone contouring, prior to radiation therapy for head and neck malignancy, and prior to cardiac surgery with valve replacement. The procedure can also be done in conjunction with any medical diagnosis where there is a risk of complications from oral infection.

CDT and ICD-10 Codes to Report Alveoloplasty

CDT codes

  • D7310 – alveoloplasty in conjunction with extractions – four or more teeth or tooth spaces, per quadrant (used when bone recontouring is performed involving four or more teeth or tooth spaces)
  • D7311 – alveoloplasty in conjunction with extractions – one to three teeth or tooth spaces, per quadrant

Extraction codes

These codes describe the anatomical area of bone encompassed in the alveoloplasty.

  • D7140 – extraction, erupted tooth or exposed root (elevation, and/or forcep removal). (The code description includes routine removal of tooth structure, minor smoothing of socket bone and closure as necessary.)
  • D7210 – surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated. (The code description also includes the minor smoothing of socket bone and closure.)

ICD-10 Codes

ICD-10-CM diagnostic codes indicate the specific reason for performing the extraction(s):

  • C03 Malignant neoplasm of gum
    • C03.0 Malignant neoplasm of upper gum
    • C03.1 Malignant neoplasm of lower gum
    • C03.9 Malignant neoplasm of gum, unspecified
  • C41.1 Malignant neoplasm of mandible
  • C79.89 Secondary malignant neoplasm of other specified sites
  • D10.30 Benign neoplasm of unspecified part of mouth
  • D10.39 Benign neoplasm of other parts of mouth
  • D16.5 Benign neoplasm of lower jaw bone
  • D00 Carcinoma in situ of oral cavity, esophagus and stomach
    • D00.0 Carcinoma in situ of lip, oral cavity and pharynx
    • D00.00 Carcinoma in situ of oral cavity, unspecified site
    • D00.01 Carcinoma in situ of labial mucosa and vermilion border
    • D00.02 Carcinoma in situ of buccal mucosa
    • D00.03 Carcinoma in situ of gingiva and edentulous alveolar ridge
    • D00.04 Carcinoma in situ of soft palate
    • D00.05 Carcinoma in situ of hard palate
    • D00.06 Carcinoma in situ of floor of mouth
    • D00.07 Carcinoma in situ of tongue
    • D00.08 Carcinoma in situ of pharynx
  • D37.01 Neoplasm of uncertain behavior of lip
  • D37.02 Neoplasm of uncertain behavior of tongue
  • D37.04 Neoplasm of uncertain behavior of the minor salivary glands
  • D37.05 Neoplasm of uncertain behavior of pharynx
  • K04.4 Acute apical periodontitis of pulpal origin
  • K04.6 Periapical abscess with sinus
  • K04.7 Periapical abscess without sinus
  • K08.0 Exfoliation of teeth due to systemic causes
  • K08.419 Partial loss of teeth due to trauma, unspecified class
  • L03.211 Cellulitis of face
  • M26.72 Alveolar mandibular hyperplasia
  • M26.73 Alveolar maxillary hypoplasia
  • M26.74 Alveolar mandibular hypoplasia
  • M26.79 Other specified alveolar anomalies
  • M27.2 Inflammatory conditions of jaws
  • R22.0 Localized swelling, mass and lump, head
  • R22.1 Localized swelling, mass and lump, neck
  • S01.522 Laceration with foreign body of oral cavity
  • S02.5 Fracture of tooth (traumatic)
  • T66 Radiation sickness, unspecified

Coding Tips

  • Codes D7310 and D7311 are used when the alveoloplasty is a distinct surgical procedure from extraction and/or surgical extractions.
  • These codes may be reported in addition to the extraction codes D7140 and D7210 when supported by documentation.
  • If an alveoloplasty is performed in conjunction with other separately identifiable procedures, modifier -51 has to be attached.

Just like any other surgical procedure, alveoloplasties must also be accurately documented in the patient chart. Failing to document the reason for the procedure and accurately describe the surgical procedure may lead to the claim denials by payers. Assigning inaccurate codes can also adversely affect reimbursement or lead to unnecessary delays in claims processing. Reliable dental billing services provided by experienced companies can help dental practices report services correctly on claims.

How To Code Dental Conditions In Older Adults [Infographic]

How To Code Dental Conditions In Older Adults [Infographic]

Dental conditions such as tooth decay, inflammation and bleeding in gums occur in older people due to inadequate nutrition, eating habits, usage of medications, poor oral care, and so on. Practicing good dental habits such as brushing the teeth twice daily with fluoride toothpaste, flossing the teeth every day and undergoing regular and professional dental cleanings can reduce the risk of dental problems. Identifying such symptoms early can help prevent dental conditions in the long run.

To get correct reimbursement for the services provided, dental offices must be up to date with the correct medical codes and payer guidelines. Practices can rely on professional dental billing companies to ensure accurate claim submission. Reputable providers offer the services of AAPC-certified coding specialists to ensure accurate and timely dental billing.

Check out the infographic below

Dental Conditions

Pros And Cons Of Porcelain Dental Veneers

Pros And Cons Of Porcelain Dental Veneers

Porcelain veneers are one of the most effective cosmetic dental options to improve the cosmetic appearance of your teeth and get the smile you desire. Veneers are a porcelain cover placed over the front surface of healthy teeth to improve their color, shape and appearance without affecting their structure. Porcelain veneers are an expensive dental restoration and insurance coverage is generally not available for veneers for cosmetic reasons. But there are non-cosmetic reasons to provide veneers and if the dentist documents medical necessity, even veneers can be a covered service. Dental billing companies are well aware of the coding and billing considerations for dental veneers.

The American Dental Association describes veneers as “a permanent change used to correct tooth imperfections, such as stained or chipped teeth”. Dental veneers are ultra-thin shell made of natural tooth-colored porcelain or composite that is fixed over the front surfaces of the teeth to correct various issues and improve appearance. The placement of porcelain veneers is usually a pain-free procedure. They are a great option for people who are looking to resolve concerns such as:

  • Teeth that are discolored as a result of root canal treatment, stains from medications, excessive fluoride, large resin fillings, and other reasons.
  • Teeth that are worn down, chipped or cracked
  • Misaligned, uneven, or irregularly shaped teeth
  • Uneven teeth, gaps, and crowding

Veneers are expensive and permanent, and you need to evaluate their pros and cons before going ahead. First, let’s look at what would make you a good candidate for porcelain veneers.

Who is an Ideal Candidate for Porcelain Veneers?

Generally, you are ideal candidate for porcelain veneers if you have badly stained teeth and minor imperfections that you want to correct. An ideal candidate for this dental procedure would have:

  • Chipped, discoloured, fractured or undersized teeth
  • Healthy, decay-free teeth
  • No indications of gum disease
  • Proper bite alignment
  • Sufficient amounts of tooth enamel to support the veneer
  • No history of habitually grinding or clenching the teeth
  • Good oral hygiene practices

Now that you have the basic information, you can make an informed decision about getting porcelain veneers by carefully considering their pros and cons.

Pros

Porcelain veneers can brighten your smile, fix minor cosmetic concerns, and replace worn enamel.

  • Address worn enamel concerns: Certain foods and beverages can cause tooth enamel to become worn or dull over time. Tooth enamel can become worn out due to genetic reasons. As opalescent porcelain veneers replicate the translucency of real enamel, they are ideal for restoring smiles affected by enamel abrasion or enamel erosion. By covering your teeth, veneers also provide protection from tooth sensitivity.
  • Look and feel natural: To make your porcelain veneers, your dentist will take impressions taken directly from your teeth. The veneers are then carefully crafted to look and feel natural in your mouth. You won’t notice anything different when you are talking, eating, or doing anything with your teeth. As veneers look natural, no one will know you had the work done unless you tell them.
  • Durable and long lasting: Porcelain veneers have a long-lasting finish, are mostly stain-resistant, and are strong enough to tolerate biting force. They are actually harder than natural enamel and if cared for well, can last up to 10-15 years on average.
  • Provide quick, customized results: Dental veneers are a highly effective and easy way to improve the appearance of your teeth. They provide instant results and getting them fixed would take just a few weeks with just 2-3 appointments with your dentist. At the initial consultation, your teeth will be evaluated and the nature of the issue to be corrected will be identified. An impression will be taken of your teeth and their color will be recorded. As veneers come in a wide variety of shapes, sizes, and shades, your dentist will work with you to find the perfect color and fit. You will be provided with temporary veneers till your permanent ones are ready. Very little preparation is required before veneers are fitted as they are customized and contoured to bond with your teeth.
  • Overcome wear and tear issues: Aging can cause natural wear and tear of the teeth and they can develop chips and cracks and discoloration. While improving your smile, porcelain veneers help improve the overall strength of your teeth by providing a durable layer to their outer surface. Veneers can restore the natural appearance of your teeth and also make them look and feel better.
  • Fix gaps between front teeth: If small teeth gaps are spoiling your smile, you can count on veneers to fix the problem. Veneers last longer than bonding, another option to fix gaps. A small amount to surface enamel will be removed on either side of the gap and a porcelain veneer will be designed to fill the gap. Veneers last longer than bonding, another option to fill teeth gaps.
  • Promote better oral care: Veneers promote better dental hygiene. You will be better motivated to take care of your newly acquired beautiful smile with proper brushing and flossing. This extra attention will help keep your teeth and gums in good condition. Your dentist will explain how you can maintain your veneers. Make sure to schedule regular dental checkups to keep your veneers looking beautiful

Cons

Like all dental restorations, porcelain veneers have their downsides.

  • Cost: One of the major disadvantages of porcelain veneers is their cost. As they are typically provided for cosmetic reasons, veneers are not covered by dental insurance plans. Highly durable, robust veneers are very expensive and affordable veneers have a shorter lifespan. Factors affecting the price of porcelain veneers include the type of veneer used, the number of teeth restored, the location of the dental practice, and the cosmetic dentist’s work experience. If additional dental treatments are required as part of your porcelain veneer treatment, the total costs will be higher. Many practices offer discounts and financing plans for dental veneers and other procedures.
  • Breakage cannot be fixed: Porcelain veneers can chip and crack. After veneer placement, some people experience an increase in tooth sensitivity to heat and cold, though this can be managed with specific products. If these veneers break, it may be difficult to fix them and they may have to be replaced.
  • Irreversible: The dentist has to remove a thin layer of enamel from the teeth before fitting porcelain veneers over them. As the enamel cannot be restored, dental veneers are irreversible. Many veneers have to be replaced after a period of 10-15 years. You can opt for another type of dental restoration solution.
  • Risk of tooth damage: Though it happens rarely, the underlying dentin can become damaged when the enamel is being removed. Also, a veneer that are not properly fitted can affect bite alignment, and leading to tooth sensitivity, discomfort while eating, and in extreme cases, even jaw pain.
  • Shorter life span: Compared to bridges and dental crowns, veneers have a much shorter lifespan. The reason is because veneers are thinner than crowns. Also, if there was some enamel erosion during the first treatment, there may not be sufficient material for a second fitting.
  • Usually serve only cosmetic purposes: Veneers usually serve only cosmetic purposes, and your dentist will likely recommend crowns if you have decay, cracks, or excessive wear. Porcelain veneers cannot be used for restoring badly failing teeth.

Knowing dental insurance companies’ policies and performing dental insurance verification is crucial for dental practices to get proper reimbursement for any treatment. Outsourcing dental billing to an experienced service provider can help practices get paid while they provide patients with the best options for their needs.

How Can Outsourcing Of Back Office Functions Help A Dental Office During Worker Shortage

How Can Outsourcing Of Back Office Functions Help A Dental Office During Worker Shortage

During the public health emergency prompted by COVID-19, many states issued orders instructing dental offices to cancel or postpone elective or non-urgent procedures that could be delayed without much risk to the patient’s health. In April 2020, CNBC reported that the health care sector lost a record 1.4 million jobs and that dental practices accounted for over half a million job cuts. According to the American Dental Association, all but 3% of dental offices nationally were shut down except for emergency appointments in March last year and nearly 9 out of 10 had laid off staff. Many practices resorted to teledentistry to deliver virtual care and dental billing companies played a key role in helping them manage their revenue cycle.

Dental and medical offices across the U.S. are now reopening in a phased manner based on recommendations and mandatory safety and health standards issued by the Occupational Safety and Health Administration. With the worker shortages driven by the COVID-19 pandemic, it would be highly beneficial for dental practices to outsource their back office duties as they navigate the challenges of reopening.

2020 IDA Survey reveals Major Dental Office Staffing Concerns

Data released by the Indiana Dental Association (IDA) in July 2020 provides a clear picture of the negative impact that the COVID-19 pandemic has had on dental practices in the state. At the time of the IDA survey, many dentists and dental offices were still suffering from acute and sustained financial losses due to the COVID-19 pandemic. Dental offices had been experiencing staffing shortages prior to the pandemic and many reported worsening of the situation. Key findings of the IDA 2020 survey include:

  • Up to 60% of dentists reported their office is still not operating at full capacity
  • Many dentists reported trouble filling positions
  • 37% of dentists reported that some of their staff quit or retired
  • 17.6% reported having trouble filling office staff positions

The problems experienced by practices due to staffing challenges included

  • not being able to schedule as many treatments, and
  • the office failing to run smoothly

The reasons mentioned cited for not being able to find dental staff were:

  • Fear of returning to works
  • Competition for qualified staffs
  • Unemployment benefits

In the new normal, dental practices need to review their staffing practices. According to a 2020 Dental Economics article, this may mean not employing as many staff as they previously did, changing employees’ duties, reducing hours or pay, and so on. The goal should be to keep the business functioning. In this situation, outsourcing dental back office duties can benefit both the practice and patients.

Benefits of Dental Back Office Outsourcing during the Pandemic

Dental practices can reemploy furloughed or temporarily laid off employees, but staffing levels should align with the level of business to ensure expenses are in line with budgeted costs and revenue. This means that not everyone, including back office staff, can be brought back. In the circumstances, outsourcing the back office to a dental billing company is a practical solution to rein in costs while promoting better patient care and practice efficiency. Experienced service providers can take care of the entire billing cycle, from the front desk and dental eligibility verification to patient scheduling, dental billing and coding, accounts receivable (AR) management, and more.

Dental insurance verification services provided by outsourcing companies involve verifying coverage benefits for both new and existing patients before they are treated. The process involves verifying the following details for each patient:

  • Effective coverage dates
  • Waiting periods
  • Maximums and deductibles
  • Treatment history
  • Benefits used to date
  • Type of plan and fee schedule
  • Claim submission information (address, phone number, payor ID etc.)
  • Coverage percentage by category
  • Implant and orthodontic coverage
  • Frequencies, limitations, and exclusions
  • Missing tooth clause, and more

With a dedicated dental insurance verification expert managing this time-consuming and often complex task, dentists can rest assured that claims go out accurately and are paid in a timely manner. Proper insurance verification means reduced risk of denials and happier patients and is one of the most important aspects when it comes to improving the practice’s bottom line.

Patient scheduling involves optimizing the appointment system to maintain a steady patient flow. Managing patient scheduling can be a challenge when adhering to COVID social distancing mandates. Outsourcing companies can provide efficient online patient scheduling and appointment management solutions to help dental practices improve patient flow.

A dental billing company will work on your software to manage your coding and invoicing. Billing specialists stay up to date with coding changes and industry regulations and can ensure accurate claim submission. They will ensure you have an efficient AR operation that gets you paid accurately and faster.

To sum up, outsourcing back office duties during the COVID-19 pandemic can help improve dental practice efficiency and improve the patient experience. It will allow dentists to focus better on patient care and their (limited) staff to save valuable time that would go into verifying patient coverage. Outsourcing insurance verification and authorization to a specialist will also ensure eligibility review before the appointment, which is crucial to prevent claim denials due to eligibility problems.

The IDA survey reported that dental practices suffered loss of income due to staffing challenges associated with inability to meet demand, patient fear resulting in reduced demand, and new clinic protocols resulting in lower productivity. It’s clear that in these challenging times, dental practices need to find cost-effective ways of managing their operations. A reliable dental billing service provider can help them overcome back office staffing shortage and navigate office reopening more easily.

How To Code Stomatitis And Related Lesions In Dentistry

How To Code Stomatitis And Related Lesions In Dentistry

Stomatitis is an oral condition referred to as inflamed and sore mouth. This is a type of mucositis, caused by inflammation of the mucous membrane. It can disrupt one’s ability to eat, talk, and sleep. It can occur anywhere in the mouth, including the inside of the cheeks, gums, tongue, lips, and palate. The treatment often focuses on managing the symptoms. Dentists treating this condition can rely on professional dental billing companies to get the dental claims submitted with the right diagnosis and procedure codes.

ICD-10 Codes to Report Stomatitis and Related Lesions

  • K12 Stomatitis and related lesions

    • K12.0 Recurrent oral aphthae
    • K12.1 Other forms of stomatitis
    • K12.2 Cellulitis and abscess of mouth
    • K12.3 Oral mucositis (ulcerative)

      • K12.30 …… unspecified
      • K12.31 …… due to antineoplastic therapy
      • K12.32 …… due to other drugs
      • K12.33 …… due to radiation
      • K12.39 Other oral mucositis (ulcerative)

Additional codes can be used to identify:

Alcohol Abuse and Dependence

  • F10 Alcohol related disorders

    • F10.1 Alcohol abuse
    • F10.2 Alcohol dependence
    • F10.9 Alcohol use, unspecified

Exposure to Environmental Tobacco Smoke

  • Z77.22 Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)

Exposure to Tobacco Smoke in the Perinatal Period

  • P96.81 Exposure to (parental) (environmental) tobacco smoke in the perinatal period

History of Tobacco Dependence

  • Z87.891 Personal history of nicotine dependence

Occupational Exposure to Environmental Tobacco Smoke

  • Z57.31 Occupational exposure to environmental tobacco smoke

Stomatitis coding excludes

Cancrum oris, noma and gangrenous stomatitis

  • A69.0 Necrotizing ulcerative stomatitis

Cheilitis

  • K13.0 Diseases of lips

Herpesviral [herpes simplex] gingivostomatitis

  • B00.2 Herpesviral gingivostomatitis and pharyngotonsillitis

The types of stomatitis include canker sore or aphthous ulcer, cold sores or fever blisters and mouth irritation. While canker sores appear as ulcers in the mouth, usually on the cheeks, tongue, or inside the lip, cold sores appear as fluid-filled sores on or around the lips. At the same time, mouth irritation can be caused due to gum disease (gingivitis), chewing tobacco, oral inflammation and ulcers or any other type of mouth infection. Such sores can be caused by poor nutrition, stress, mouth injury, a weak immune system, lack of sleep, hormonal changes, or side effects of chemotherapy and sometimes radiotherapy. Depending on the area of the mouth affected, stomatitis can be broken down into different categories such as – cheilitis (inflammation of the lips and around the mouth), glossitis (inflammation of the tongue), gingivitis (inflammation of the gums) and pharyngitis (inflammation of the back of the mouth).

Common symptoms include mouth ulcers, red patches, swelling, lesions that heal in 4 days – two weeks. Treatment options for severe sores include Lidex gel, Aphthasol anti-inflammatory paste, Peridex mouthwash, and anti-inflammatory drugs like corticosteroids. To submit error-free medical claims, practices can consider partnering with an experienced dental billing service. Make sure that the coders are up to date with the changing coding standards.

Our services include

At Outsource Strategies International (OSI), our comprehensive suite of dental billing services include comprehensive dental eligibility verifications and other services to help run your practice efficiently.

  • Patient Scheduling and Registration
  • Authorizations & Pre-determinations
  • Payment and Cash Posting
  • Insurance Billing and Collections
  • Patient Billing and Follow-up
  • Accounts Receivable Management

Call our toll-free number 1-800-670-2809