Exorbitant Dental Bill? Medical Insurance May Cover Some of It


Once he investigated the matter, Dr. Farrugia discovered that medical insurance could be asked to cover not just CT scans but a wide range of services regularly performed by dentists. He buried himself in the arcana of coding, ultimately writing three workbooks for dentists about medical billing.

At first it was trial-and-error, and Dr. Farrugia learned that claims often get rejected if they do not cite a medically legitimate reason for the procedure as well as the appropriate code.

These days, Dr. Farrugia bills medical plans $744 for a CT scan (medical code: CPT 70486), receiving an average reimbursement of about $500. Medical plans generally require pre-authorization for nonemergency CT scans, he said, so his office staff had to learn how to explain why the scan was medically required — such as to assess bone quality.

The same procedure can be billed to a dental plan (dental code: D0367), but the average reimbursement is $125 — if the plan covers CT scans at all. Others are following his example. Dr. Richard Downs, a dentist from Iowa, attended one of Dr. Farrugia’s medical billing seminars last year in Chicago. “I’d never heard these things before,” he said. He said he recently sought and received prior authorization from a medical insurer for $60,000 to cover multiple implants and other costs for a woman whose dental woes stemmed from severe atrophy of the jaw and other medical problems.

During a break in the seminar, Dr. Rashpal Deol, a dentist from San Ramon, Calif., said Dr. Farrugia’s approach made sense. “We look at the soft tissues in the mouth, the muscles, the bone, the TM [temporomandibular] joint, and the head and neck area,” he said. “You always check the lymph nodes, we do oral cancer screening, so that is a comprehensive medical exam.”

Other seminar attendees also were enthusiastic, if a bit daunted. “People go to school to learn medical coding,” said Kelly Bradshaw, a staff member at a dental practice in Santa Rosa, Calif. “To try to bridge that gap in order to help our patients is intimidating. You have to be open-minded to look at things in different ways.”

Margaret Busch, an office manager for an Arizona dentist, said she planned to start medical billing as soon as she returned from the seminar.



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