Documentation for the Billing and Reimbursement of Laser Procedures

Transcription

1 Documentation for the Billing and Reimbursement of Laser Procedures This presentation is supported by BIOLASE through an unrestricted educational grant. Presented by Tom M. Limoli, Jr. Limoli and Associates, LLC Recognition and Credits PennWell is an ADA CERP recognized provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at PennWell designates this activity for 1 Continuing Education Credit. Dental Board of California: Provider 4527, course registration number This course meets the Dental Board of California s requirements for 1 unit of continuing education. The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2011) to (10/31/2015) Provider ID# Disclosure Declarations Presenter Disclosure: To m M. Limoli, J r. has nothing to dis c los e. Commercial Support: This course was developed with commercial support provided by Biolase. Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity, No manufacturer or third party has had any input into the development of course content. CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with any commercial supporter, or with products or services discussed in this educational activity. Heather can be reached at hhodges@pennwell.com. Image Authenticity: No images in this educational activity have been modified or altered. Scientific Basis: All content has been derived from references listed and the author s clinical experience. Research references are provided in the bibliography and/or supplemental materials. Educational Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise. 1

2 Educational Objectives Identify the various components of the global procedure Provide requested supplemental information automatically without the need for crafting canned narrative reports. Streamline and simplify the overall reimbursement process by accurately documenting the most critical aspects of the patient s treatment. Global Procedure of What, Why and How The global surgical package, also called the global procedure, includes all necessary services as well as subcomponents normally furnished by a practitioner before, during, and after a procedure. Global Procedure of What, Why and How An individual course of treatment, or procedure(s), is established depending on the doctors specific diagnosis as well as the treatment needs of the patient. 2

3 Global Procedure of What, Why and How Procedure codes identify only what was done not why. Benefit plans pay claims based upon both what and why the procedure was performed. Global Procedure of What, Why and How In the old days offices searched for repeatable canned narratives to justify fictitious treatment need as well as entice and sometimes fool an insurance company into inaccurate payment. Federal healthcare reforms are and have rapidly ended many of these practices. Global Procedure of What, Why and How Today, reimbursement management is at the brink of major overt simplification. Clinical documentation and diagnostic coding is rapidly becoming the cornerstone of claims payment. 3

4 Global Procedure of What, Why and How To simplify the process in your office make sure your clinical documentation supports not only What but Why an individual procedure was needed on behalf of a patient. Laser technology automatically provides for you the HOW. Attached please finds a copy of our clinical documentation from the date of service A Few Thoughts To Consider Code D7465 is the one and only procedure code that is specifically technique sensitive to the laser. Rather than being surgically removed, the pathologic lesion is simply obliterated. 4

5 A Few Thoughts To Consider For all other procedures where the laser is used, report the code that most accurately describes the intended procedure. A Few Thoughts To Consider For a frenectomy, the code is D7960. A Few Thoughts To Consider For a gingivectomy, the code is either: D4210 (four or more teeth per quadrant) D4211 (one to three teeth per quadrant) or D4212 (for later restorative access) 5

6 A Few Thoughts To Consider We must remember that a laser is nothing more than an adjunctive instrument that s technique is utilized to complete a definitive procedure. A Few Thoughts To Consider You would not code separately based on the fact that you used an #11 or #15 Bard-Parker blade. A Few Thoughts To Consider Insurance companies and third party carriers accepts no additional liability for the use of a laser or for that matter the use of a curved or straight surgical blade. 6

7 A Few Thoughts To Consider Current Dental Terminology and its Code on Dental Procedure and Nomenclature are used to identify completed procedures, not specific techniques. Limoli s Trilogy of Reimbursement Is it legible Effective Record-Keeping Requirements 7

8 Effective Record-Keeping Requirements It contains only those terms and abbreviations that are comprehensible to similar licensees. Effective Record-Keeping Requirements It contains adequate identification of the patient. Effective Record-Keeping Requirements It indicates the specific date of any professional service provided. 8

9 Effective Record-Keeping Requirements It contains pertinent and significant information concerning the patients condition. Effective Record-Keeping Requirements It reflects what examinations, vital signs and tests were obtained, performed or ordered, and the findings and results of each. Effective Record-Keeping Requirements It indicates the initial diagnosis and the patient s initial reason for seeking the licensee s service. 9

10 Effective Record-Keeping Requirements It indicates the medications prescribed, dispensed or administered, and the quantity and strength of each. Effective Record-Keeping Requirements It reflects both the treatment recommended as well as performed. Effective Record-Keeping Requirements It documents the patient s progress during the course of treatment as provided by the licensee. 10

11 Limoli s Six R s of Record-Keeping Reason Why is the patient here today? Review What is the patient s overall health status today? Evaluation of the patient s dental needs and description of condition. 11

12 Radiographs Are radiographs needed? Why are they being taken? Document what they show. Recommended Treatment Based upon the evaluation and diagnosis, what treatment is recommended by the dentist? Remove Repair Replace Rendered Treatment What procedures were performed? What anesthesia was used? Other materials used? 12

13 Response to Treatment How did the patient s condition respond to treatment? What are the next steps or follow-up procedures? Now Begin With Evaluation Pretreatment Diagnostics The four components of a SOAP note are Subjective Objective Assessment Plan 13

14 Subjective Initially is the patient's Chief Complaint, or CC. This is a very brief statement of the patient (quoted) as to the purpose of the office visit. Objective The objective section of the SOAP includes information that the healthcare provider observes or measures from the patient's current presentation. Assessment The assessment section is a quick summary of the patient main symptoms/diagnosis. It is the patient's progress since the last visit, and overall progress towards the patient's goal from the doctors perspective. 14

15 Plan The plan is what the doctor or health care provider will do to treat the patient's concerns Guidelines for Clinical Documentation A copy of your clinical documentation for the date of treatment (as well as both prior to and following) is your most powerful and automatically generated narrative report. Guidelines for Clinical Documentation The benefit plan needs to have the individual patient specific clinical details in order to appropriately pay the claim. 15

16 Documenting All Three General Surgical Services Periodontal Surgical Services Operative Surgical Services Pretreatment Documentation Todays date of service Date of previous visit Reason for visit / chief complaint Medical history changes since last visit Pharmaceutical changes since last changes Radiographic interpretation of diagnostic quality labeled and dated Photograph labeled and dated Additional supplemental documentation Previous history of any surgical intervention General Surgical Services Treatment rendered via quadrant / sextant Clinical notations specifying necessity for soft hard tissue removal For The Purpose Of Soft tissue ablation setting Tip, w, Hz, H20%, air%, mode Hard tissue ablation setting Tip, w, Hz, H20%, air%, mode Anesthetic agent local topical type dosage 16

17 The Procedures Conclusion Post operative instructions prescriptions Anticipated next visit follow-up Periodontal Surgical Services Treatment rendered via quadrant / sextant Clinical notations specifying necessity for soft hard tissue removal For The Purpose Of Soft tissue ablation setting Tip, w, Hz, H20%, air%, mode Hard tissue ablation setting Tip, w, Hz, H20%, air%, mode Anesthetic agent local topical type dosage The Procedure Concludes Post operative instructions prescriptions Anticipated next visit follow-up 17

18 Operative Surgical Services Treatment rendered via quadrant / sextant / tooth Clinical notations specifying necessity for soft hard tissue removal For The Purpose Of Soft tissue ablation setting Tip, w, Hz, H20%, air%, mode Hard tissue ablation setting Tip, w, Hz, H20%, air%, mode Anesthetic agent local topical type dosage The Procedure Concludes Post operative instructions prescriptions Anticipated next visit follow-up Gingivectomy or Gingivoplasty D4210 four or more contiguous teeth or tooth bounded spaces per quadrant D4211 one to three contiguous teeth or tooth bounded spaces per quadrant It is performed to eliminate suprabonypockets or to restore normal architecture when gingival enlargements or asymmetrical or unaesthetic topography is evident with normal bony configuration 18

19 With D4210 and D4211 These preceding codes are not to be used in conjunction with any operative or restorative procedure. As the definition reads they are strictly for the removal of unaesthetic soft tissue in the presence of otherwise healthy bone Gingivectomy or Gingivoplasty D4212 to allow access for restorative procedure, per tooth With D4212 This procedure is identifiable when the removal of only soft tissue is necessary to complete a restorative procedure on the same tooth as well as operative surface(s). 19

20 With D4212 The restoration can be either direct or indirect but must be delivered following adequate healing and resolution. If the restoration is delivered on the same date the gingival preparation will be considered part of the restoration and the fee not collectable. With D4212 This is strictly a removal soft tissue. Bone is not and will not be involved. Surgical Excisions D7410 benign lesion up to 1.25 cm D7411 benign lesion greater than 1.25 cm D7413 malignant lesion up to 1.25 cm D7414 malignant lesion greater than 1.25 cm 20

21 With Surgical Excisions Of critical importance is the significance that these are single focus stand-alone procedures and are not billed in conjunction with any other surgical or operative procedure(s) in the same surgical area, by the same dentist or dental office. The pathology laboratory report of diagnostic findings is going to be required and may be billed separately. Surgical Excisions D7465 destruction of lesion(s) by physical or chemical method, by report Examples include using cryo, laser or electro surgery. Other Repair Procedures D7960 frenulectomy also known as frenectomy or frenotomy separate procedure not incidental to another procedure Surgical removal or release of mucosal and muscle elements of a buccal, labial or lingual frenum that is associated with a pathological condition, or interferes with proper oral development or treatment. 21

22 Other Repair Procedures D7963 frenuloplasty Excision of frenum with accompanying excision or repositioning of aberrant muscle and z-plasty or other local flap closure. With D7960 and D7963 Of critical importance is the significance that these are single focus stand-alone procedures and are not billed in conjunction with any other surgical or operative procedure(s) in the same surgical area, by the same dentist or dental office. Reimbursement Management is Simple Follow Tom s Seven Keys to Reimbursement Success 22

23 Rule 1 Diagnose and document prior to initiating any treatment Rule 2 Establish a written treatment plan for the patient as well as yourself Rule 3 Secure financial arrangements prior to treatment 23

24 Rule 4 Patient must acknowledge and agree to pay the total fee prior to insurance consideration Rule 5 Bill and code for exactly what dated service are rendered and completed Rule 6 What the insurance does not pay the patient must pay 24

25 Rule 7 If the patient does not pay hunt them down like you would a rabid dog Thank You! Questions, comments or inquiries: tom@limoli.com This presentation is supported by BIOLASE through an unrestricted educational grant. To claim CE credit for your participation in this activity you must complete the program post-exam. Instructions for completing the post-exam and receiving your Letter of Credit are provided on the following slide. 25

26 Continuing Education Credits To receive CE credit for participating in this program you must complete the online post-exam and evaluation. To complete the online post-exam click the Claim CE Credit button. On the returning page click the Take Exam link displayed directly across from the course title. Complete the online exam and submit it. An immediate grade report will be prov ided (for c redit you mus t sc ore 70% or higher). Click Continue and complete the online program evaluation. Once submitted your Letter of Credit can be accessed by selecting the Print/View Certificate link displayed from within the MyCE Archives. Letters of Credit are immediately available from within the MyCE Archives page for viewing and/or printing at ANYTIME in the future. Future access to your CE records may be obtained by signing back in to this CE event website. Claim CE Credit 26