Anytime a specialist is required, dental billing can seem intimidating. Billing for any dental procedure takes time and effort, so surely, billing for a specialty procedure must be complex. In this ongoing series, we will offer insight into the nuances of specialty billing practices, continuing with endodontic billing.
What is Endodontics?
Endodontics refers to the treatment of the soft tissues inside the tooth, also known as the dental pulp. An endodontist completes this treatment, although occasionally, a general dentist may complete a simple root canal. According to the American Association of Endodontists, endodontists are “highly skilled dental specialists in diagnosing and treating tooth pain and performing root canal treatment.”
What attachments do I need to include in an endodontic claim?
The doctor’s narrative and x-rays are essential items that need to be attached to an endodontic claim. The narrative should thoroughly explain what treatment was completed and why it was completed. The x-rays should always be periapical in order for the entire root of the tooth to be visible. Chart notes and intraoral photos can also be included if they add additional insight into the claim.
Do I need a referral?
When billing a PPO insurance, you don’t need a referral, but it may be required for an HMO plan. If a general dentist completed the root canal, a referral isn’t necessary. If an endodontist completes a root canal, the HMO plan won’t consider the claim without it. Some carriers require treatment to be pre-authorized, so always check when verifying insurance coverage if it is needed.
How do I bill a root canal?
When billing a root canal, it is essential to include a doctor’s narrative and at least three periapical x-rays. The first, a pre-treatment x-ray, must show the entire root of the tooth and area of infection. The second, taken in-treatment, should indicate the file in place. The final, a post-treatment x-ray, must show the full root with the pulp removed and filling in place. While the insurance carrier may cover the claim with only the pre and post-treatment x-rays, it is best to send all three.
Why was my obstructed canal claim denied?
Insurance carriers are suspicious of upcoding when it comes to obstructed canals. Because of this, carriers often deny them. The key to avoiding an insurance denial is sufficient chart notes and clear x-rays. The chart notes must indicate the percentage of the canal that is obstructed, and, in addition to the three root canal x-rays, a fourth x-ray must show the calcification of the canal.
Can I bill insurance for an incomplete root canal?
If you cannot complete a root canal, you can bill the insurance. There is a specific CDT code (D3332) just for this scenario. When a root canal cannot be completed, attach a doctor’s narrative explaining why and detailing the new treatment plan. Also, be sure to include x-rays supporting the incomplete treatment.
How do I bill a root canal retreatment?
When billing a root canal retreatment, include a doctor’s note and three periapical x-rays, just as you would with an initial root canal. In addition, have the date the prior root canal was completed. Most carriers require at least the month and year, so locate the previous date in your chart notes. If the patient was treated elsewhere, you must obtain the date from them or their previous dentist. Also, root canal retreatments are subject to frequency limitations, and most carriers won’t cover them if completed within 12 months of the initial treatment.
As you can see, various processes are involved in endodontic billing, but when learned, they can be easily managed. If you’re struggling with endodontic or other specialty claims, consider outsourcing your dental billing. At eAssist, our Success Consultants are knowledgeable about the various nuances of endodontic treatment and will ensure your claim is billed correctly. To learn more, complete the form below.
