FYI

Dentist blog from Delta Dental

Author: Delta Dental (Page 2 of 37)

Upcoming webinars for January: Provider Tools and Community Care Network

If you’re looking to get 2022 off to a great start, why not begin by registering for one of Delta Dental’s free webinars? You can learn how to increase your office productivity with Provider Tools and how to expand your patient base by joining the Department of Veterans Affairs (VA) Community Care Network.

Provider Tools

Our Provider Tools webinars can increase your office productivity by teaching you important skills like how to submit claims online or enroll in direct deposit. Get the top pro tips and answers to the most frequently asked questions about Provider Tools.

This month’s Provider Tools webinars are:

If you have a specific question about Provider Tools, you can also schedule a 1:1 video call.

As we continue to expand our webinar offerings, we would love to hear from you. If there are any topics you’d like to us to address, share your thoughts with us at providertools@delta.org.

Community Care Network

Our new VA Community Care Network (VA CCN) introductory webinars provide an overview of the CCN. We’ll help you gain access to valuable resources and share helpful information about expanding your patient base with the CCN.

This month’s webinars are:

Glaucoma and its surprising connection to oral health

January is National Glaucoma Awareness Month. Learn more about the diseases link to oral health and what you can do for your patients with glaucoma.

What is glaucoma?

Glaucoma occurs when a buildup of fluid causes pressure in the eyes to increase to abnormal levels, damaging the optic nerve. The resulting nerve damage causes partial or total blindness in the affected eye. After it occurs, this vision loss can’t be reversed, but early treatment to reduce eye pressure may reduce or halt the damage.

More than 3 million people in the United States have glaucoma, and the number of people who have the disease is expected to more than double by 2050, according to the National Eye Institute. While anyone, including children, can get glaucoma, the condition is most common in:

  • People over age 60
  • African Americans over age 40
  • People who have a family history of the disease

OK, but how is glaucoma connected to oral health?

Various studies suggest a connection between poor oral health and glaucoma. A 26-year study of more than 40,000 men over the age of 40 found a correlation between tooth loss and primary open-angle glaucoma.

The study found that the risk for glaucoma was 43% greater in men who had lost at least one tooth than those who didn’t lose any teeth. When periodontal disease was also factored in, the glaucoma risk for men with tooth loss increased to 86% higher than men with no tooth loss.

While the specific cause isn’t certain, researchers speculate that bacteria at the site of the tooth loss can cause inflammation, which triggers microbes and cytokines that can affect the eyes.

What can I do for my patients with glaucoma?

If you have patients who been diagnosed with glaucoma, here are few steps you can take to help control the condition and make their visit easier:

How teledentistry can bring value to your practice

Since the start of the COVID pandemic, the use of teledentistry has increased significantly. This has created intriguing — and potentially lucrative — opportunities for dental practices. Are you taking full advantage of this new technology? Dr. Daniel Croley, Delta Dental’s chief dental officer, explains how.

In his new Dental Economics magazine article, “The value teledentistry visits bring to dentists and their patients,” Dr. Croley talks about the intrinsic value of teledentistry, the various types of teledentistry and how teledentistry can bring value to your dental practice and patients.

It’s no surprise that the pandemic accelerated the adoption of telehealth across the medical and dental spheres. As dental offices learned to navigate lockdown measures, extended safety protocols, and assuaged patients’ fears of becoming exposed to the virus via the dental office, virtual care has only scratched the surface of its potential in teledentistry. The market is expected to reach $2.6 billion by the end of the decade.

Dr. Daniel Croley 

Read the full article in Dental Economics.

Why your SRP claims are denied and what you can do

Claims for periodontal scaling and root planing (D4341 and D4342) are denied more frequently than those for many other procedures, according to the American Dental Association.

Delta Dental defines periodontal scaling and root planing (SRP) as “a definitive non-surgical periodontal treatment involving the judicious and thorough planing of the root surface.” The procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus.

Although you should always refer to the Delta Dental Dentist Handbook for specific processing policies and guidelines, we’ll highlight some common reasons for denials for SRP and associated procedures.

Documentation fails to support payment of SRP

Delta Dental considers a quadrant of procedure D4341 to consist of at least four diseased teeth (4-6mm pockets, early bone loss).

  • When fewer than four diseased teeth are involved, Delta Dental bases its allowances on procedure D4342.
  • In addition to qualifying pocketing, radiographs must show loss of alveolar crest height beyond the normal 1-1.5mm distance to the cemento-enamel junction (CEJ).
  • Exposure of cemental surfaces of the roots is necessary for root planing.
  • Without a reduction in the alveolar crest level, root planing isn’t achievable.
Qualifying: X-rays clearly shows appreciable bone loss and calculus
Non-qualifying: X-rays show no appreciable bone loss and calculus 

Denial code: 5F8. Submitted documentation fails to support payment of benefits for scaling and root planing.

Submission of more than two quads of SRP on the same date of service

Without supporting documentation, the fees for more than two quadrants of SRP performed on the same date of service are disallowed. Acceptable supporting documentation includes:

  • Clinical progress notes
  • Evidence of length of appointment (successful scaling typically takes 30-45 minutes per quadrant with local anesthesia)
  • Information about the local anesthetic used
  • The reason for performing more than two quadrants on the same date of service

Four quadrants of SRP may be approved on a pre-authorization when criteria are met. However, you’re expected to know the policy upon payment.

Denial code: 447. No more than two quadrants of scaling and root planing are allowable on the same date of service.

Inadequate periodontal charting or x-rays

The D4341 and D4342 procedures require you to submit periodontal charting that indicates at least Case Type II periodontal disease (4-6mm pockets, early bone loss).

  • Periodontal charting should be dated no more than 12 months before the date of service.
  • Full-mouth series or bitewings that clearly show appreciable bone loss are preferred because these images are usually the most accurate determinant of bone loss.
  • Submit corresponding images for each submitted quadrant.
Qualifying: Labeled periodontal charting that indicates exam date
Non-qualifying: X-ray is non-diagnostic as interproximal contacts are overlapped and fail to show bone loss

Denial codes:

  • 5F8. Submitted documentation fails to support payment of benefits for scaling and root planing.
  • 574. Benefits could not be determined because of missing periodontal charting.
  • 570. Benefits could not be determined because of missing pre-operative radiographic images.
  • 573. Benefits could not be determined because of missing full mouth radiographic images.
  • 569. Benefits could not be determined because of the non-diagnostic nature of the radiographic images submitted.
  • 426. Benefits could not be determined because of missing radiographic images, periodontal charting, and treatment record.
  • 5GB/5GC. Submit current periodontal chart, dated pre-operative diagnostic radiographs, and a copy of the patient treatment record.

Associated denials related to SRP

Gingival irrigation (D4921)

Gingival irrigation isn’t a separately payable procedure when provided in conjunction with SRP or any other periodontal procedures. You can’t charge a separate fee for the procedure to Delta Dental or the patient.

Denial code: 449. The fee for gingival irrigation is included in the fee for any periodontal services performed on the same date of service.

Localized delivery of antimicrobial agents (D4381)

This procedure isn’t a benefit under some plans and requires you to submit periodontal charting indicating pockets of at least 5mm. When submitted with nonqualifying SRP, these procedures will be denied due to conflict with the denied SRP.

Denial codes:

  • 7BB. This service is not a covered benefit of the enrollee’s program.
  • 7C2. The submitted procedure is not payable due to the absence or conflict of a related service.

Unspecified periodontal procedure (D4999)

These are most commonly submitted as bacterial decontamination, laser or irrigation.

Delta Dental considers specialized techniques, such as those that use lasers or antibacterial medicaments, to be included in the fee for any SRP or surgical procedure. You can’t charge a separate fee for the procedure to Delta Dental or the patient.

Don’t forget:

  • Delta Dental pays for completed procedures, not tools used for treatment.
  • Please provide a narrative report with a complete description of the procedure and its rationale.

Denial codes:

  • 440. The fee for this procedure is considered part of and included in the fee for periodontal services.
  • 9WA. The fee for this procedure is considered to be part of, and included in the fee for, a completed service.
  • 564. Submit clinical treatment narrative.

Delta Dental’s periodontal processing policies described above should be considered guidelines. Whenever an exceptional case is involved, please provide a full narrative description and any available supporting documentation to help our staff determine benefits.

And remember, to ensure timely benefit determination, always submit the appropriate supporting documentation on your initial submission.

Your dental policy brief: Current issues and news updates as of December 14

From Medicare news to the latest on COVID policy, FYI brings you the biggest dental policy stories.

1. New Medicare Advantage network policy for dentists

The Centers for Medicare & Medicaid Services (CMS) has clarified that rules prohibiting payment to providers who have opted out of participation in Medicare don’t apply to supplemental benefits, such as dental. The new policy will become effective January 1, 2022.

The new policy means that dentists who have opted out of our Medicare Advantage (MA) network can now file MA claims, and Delta Dental will pay claims for MA enrollees who participate in closed-panel MA group plans.

Note that Delta Dental can accept and pay these claims from dentists outside our MA network only as long as this policy remains in effect. Therefore, we strongly encourage dentists who have opted out of this network to enroll.

Our MA network provides you with a great way to keep your retirement-aged patients and continue to provide them with quality dental care. And since you’ll appear in our online MA network provider directory, you can attract new patients as well. Reimbursement is based on your current Delta Dental PPO fees.

Be advised that the MA network opt-out period is two years and will automatically renew unless you notify us 30 days before your current opt-out period ends that you’d like to enroll. Since you may not be aware that you’ve opted out, we encourage you to review your MA network status as soon as possible.

2. New York City vaccine mandate now includes dentists

All private employers in New York City, including dentists and their employees, must be vaccinated against COVID-19, Mayor Bill de Blasio announced December 6. The mandate will take effect December 27. Dentists and their staff must provide proof they’ve received at least one dose of the vaccine. An exception for people who agree to regular COVID-19 testing instead of the receiving the vaccine won’t be allowed.

New York state currently has a vaccine mandate for all health care workers (which the United States Supreme Court upheld on December 13); however, it doesn’t apply to private practices such as dental offices.

3. White House pledges to help address dental care shortages in underserved communities

The Biden administration announced it will invest $1.5 billion to help tackle a shortage of dentists and other health care workers in disadvantaged communities. The funding will come from the $1.9 trillion American Rescue Plan passed in March.

The resources will go to the National Health Service Corps, Nurse Corps and Substance Use Disorder Treatment and Recovery programs. These federal programs offer scholarships and assistance with student loans to health care workers and students who agree to work in underserved communities.

Upcoming CDE webinars from the University of Texas on ulcerative oral mucosal disorders

The University of Texas School of Dentistry will be holding a two-session Current Perspectives in Dentistry course covering diagnosis for ulcerative oral mucosal disorders. In this short online course, sponsored by Delta Dental, you’ll discover a practical approach to evaluating patients who present with painful oral mucositis and ulcerations and you’ll learn:

  • How to select antibiotics for orofacial infections, drugs for pain and local anesthetics
  • A current approach to formulating differential diagnoses for acute and chronic oral inflammatory and ulcerative lesions
  • About diagnostic guidelines and procedures for autoimmune ulcerative, vesiculobullous and ulcerative oral mucosal diseases
  • Rationale for the therapeutic and preventive management strategies of common oral mucositis and ulcerations

There are two sessions for this course, Part I on December 17, 2021 and Part II on January 21, 2022. Each session starts at 9 am Central time (10 am EST, 7 am PST) and ends at noon Central time.

Register online or by calling 713-486-4028. Delta Dental network dentists get a discount!

« Older posts Newer posts »

© 2022 FYI

Theme by Anders NorenUp ↑