Happy 2020 to you! Last month we held our first coding workshop of the year in Waco, Texas. We had a great seminar discussing all things coding and billing and Waco was a terrific backdrop for our meeting. As we strolled around town and saw everything “Magnolia” I was secretly hoping for a glimpse of Chip and JoJo. We did not have a sighting but we were able to have a wonderful and delicious breakfast at Magnolia Table. It was so good we went back for a second visit on our travel day home arriving at 6:00 a.m. so we could have one more Magnolia experience! It was charming and welcoming; everything we had expected it to be. A must do if you are ever in the area.
So, what is new in the OMS billing world? Well, as of 2020 we are now able to report CDT code D7922 for placement of intra-socket biological dressing to aid in hemostasis or clot stabilization, per site. Sounds like a great idea and we thought it would be a great idea however, we are finding that the majority of the carriers are not allowing for any benefits for this code and are including it as part of the extraction. So, what do you do and how do you handle this? You need to make a practice management decision to report the code when using this and potentially take the write off or not bill it at all. The only way we are going to see change within the industry, though, is for the carriers to realize how often you are providing the service. Even though you may not have success now at getting any additional reimbursement for D7922, you may want to continue to report the code to your dental insurance carriers.
Also, a new ADA form was released in 2019 and many of the software vendors have updated their system to accommodate the new claim form. The new claim form (Version 2019) has an additional field to reflect the gender of the patient and subscribers. The choices are: (M) for male, (F) female and (U) for unknown. When appropriate you can enter these choices into your software and have them auto populate on the dental claim form. There is a bit of snag you will run into, though, when you need to bill to a medical carrier. The CMS 1500 claim form was not updated to reflect these changes. A (U) in the gender box will not populate on the CMS 1500 form and your claim could be rejected by the medical carrier as an incomplete claim. Keep an eye on this when you are billing to medical carriers and double check your demographics to be sure the correct field will populate.
The landscape of insurance is constantly changing whether it’s by new network agreements between carriers, changes in employer’s insurance offerings or major coding changes. It is so important to continue to keep a pulse on what is happening in your practice. Recently in Massachusetts the largest employer in the state changed their offerings of health care plans to their employees. They made a switch from BCBS to another carrier impacting more than 75,000 employees in the state. If you were a participating provider in BCBS but not with their new carrier this change could lead to unplanned open chairs in your office. You need to be continually reviewing what is happening “out there” and how it impacts your office so you can make informed business decisions regarding insurance participation, whether it is adding a plan or dropping a plan in your practice.
Until next time…Keep Calm and Code On!
TERRI
