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   06.02.05 Issue #169

   

When Did The Technique Become The Coded Procedure?


Tom Limoli, Jr.


Traditionally, third party payers have contractually reimbursed only for completed procedures. They did not reimburse for individual subcomponents or techniques required to complete the global procedure. As an example - with all bonded restorations, the bonding is nothing more than the technique used to complete the procedure. As such, the technique sensitive procedures are simply coded as the completed procedure.

I do not recommend to the dental profession separate fees for bonded and non-bonded restorations. When taking into consideration the usual fee for the completed procedure, examine the number of bonded and non-bonded restorations that are routinely performed. The single fee should equally address both restorative techniques. The additional cost of the bonding agent is reflected in your total fee charged for the restoration.

According to previous versions of the American Dental Associations Current Dental Terminology:

"Local anesthesia is considered to be part of restorative procedures."

Well guess what? The CDT-2005 states that local anesthesia is usually considered part of the procedure.

Much has already been written concerning Evidenced Based Dentistry and its associated Parameters of Care. For those just now returning from Mars – evidence based parameters of care is nothing more than the scientific analysis of when you do what you do as compared to how you do it if you actually do anything? Or to put it simply - are we doing the appropriate treatment at the appropriate sequential time for the specific needs of an individual patient.

Parameters of care are very different and many say should not be confused with or influenced by a benefit plans parameter of payment. This two lane road moves in both directions as parameters of payment should not govern or direct parameters of care.

 Why?

A benefit plans parameter of payment are guided primarily by the strength of the plan purchasers' almighty dollar. The more one pays for a plan – the richer the benefits available to the enrollees. High dollar plans have high dollar benefits. Conversely, low dollar plans don't have a whole lot of covered benefits.

The recent articles that have graced the pages of dental periodicals and journals are praising organized dentistry's attempt to nickel and dime the American consumer by giving dentists what they feel they really want. More codes for more money from the evil blood sucking insurance companies. After all – look at all the neat codes the physicians have at their disposal. If we have more codes look at how much more money we can make. Look at how misguided the few are that lead the many down the road to ruin.

Compare the wonders of the two edged sword as concerns the medias fascination with the “extreme makeover” concept. Only a few are guided by the shallow vanity while the many fear the overall repercussions when the patient finally realizes, down the road, that they are the same emotional patient they were prior to investing thousands for their silken vale of empty happiness.

Will dentists across America now begin charging separately for that which they know is part of a separate completed procedure? Are they going to start charging based on the technique? Will we as payers be forced to address the separate charge or simply allow our insured patients to fall victim to our lack of fiduciary accountability and responsibility? Do we deny the charge and let them collect from the patient or do we disallow the charge and reduce reimbursement for the completed procedure so as to address the fee for local anesthetic?

I think not. All will be well. We don't need to throw out the baby with the bath water just yet for I don't think the bulk of America's dentists are going to abuse their patient base. Yes, there will be the greedy few. But then again, isn't the enemy of our enemy really our best friend?

Tom Limoli, Jr. is the author of “ Dental Insurance & Reimbursement Coding and Claim Submission Manual " to order click here.

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