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Examples of procedures that can be billed to medical (not limited to the list)
Sleep Apnea Therapy
Botox for “Painful Bruxism”
Other “medically necessary” services
Many US states have passed mandates that Temporomandibular Joint Disorder treatment is required to be covered under medical policies
Dental insurers require that medical is billed first. Some medical insurance policies have favorable reimbursement policies when the patient has difficultly with everyday oral function.
To request reimbursement from medical carriers, ICD 10 codes explain “why” services are being provided from a diagnosis standpoint. Every medical claim requires at least 1 (and allows up to 12) to bill any procedure to medical. The ICD-10 diagnosis code must correlate to the procedure provided
The ICD diagnosis code establishes the medical necessity of the procedure you are performing for such conditions as atrophy of the jawbone which warrants bone grafting to an edentulous area, impacted teeth, infection or cysts for extractions, TMJ articular disc disorder or Obstructive Sleep Apnea to correlate with oral appliances or orthotics
Medically necessary screening exams for oral surgery, TMJ disorders and obstructive sleep apnea can often be billed to medical insurance
If the patient has an accident affecting the teeth, unrelated to a motor vehicle or work-related accident, the medical insurance can be billed
Medical policies may cover oral appliances for obstructive sleep apnea if the specific documentation of medical necessity is sent and is complete. It’s important to become familiar with local polices in order to know what’s wanted and needed.