James Anderson

The Fraud Alert – Billing the Right Crosscode

We are all pretty familiar with the mantra for dental billing. Bill for what you do and do what you bill for. Since an office is, hopefully, bursting at the seams with dental professionals it is fairly easy to stay within the lines on dental billing. Innocent mistakes may be made but for the overwhelming majority of claims things are filed correctly with the most appropriate procedure code.
    Jump across the line to medical billing and things can get very blurry, very quickly for a new dental office seeking to send medical claims. The eAssist Dental Medical Billing department eases these problems by doing all the crosscoding for you. But maybe you’re reading this because your office doesn’t have DMB services yet and or you have the occasional need to crosscode a claim. It’s important to note that as the number of dentist submitting to medical plans has increased so have insurance companies’ cries of “fraud”. While the majority of the time fraudulent billing is an unfortunate accident the practitioner is still responsible for the errors.
    When coding for a medical claim keep in mind that the most appropriate code must be used. That means for your biopsies where there is currently only one or two dental codes there are up to 7 for each type of biopsy in medical coding. Medical coding separates biopsy codes by location in the mouth – and precision is key. When there isn’t a direct crosscode don’t try to “make” one fit. Medical codes have miscellaneous codes just like dentistry. When in doubt your best bet is to read the code carefully, choosing the one that most appropriately matches the dental code and include a good narrative for explanation.
    For diagnosis codes only code what is recorded. Patient report on medical history is fine as well as dental history but if you feel something isn’t adding up expand on it in your notes. It is important to keep in mind that many medical carriers ask for chart notes so ensuring uniformity all around is essential to a successful claim. The notes and the medical history should read like mirror images of each other. The most highly paid, promptly remitted claims are those where there is no question on what services were rendered, how they were rendered and what was the basis for the medical necessity.
 

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