Fast Facts: Coding Episode 10
Welcome back everyone! You are listening to another episode of Fast Facts- Coding Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Teresa Duncan, MS.
[Teresa Duncan, MS]
Hello and welcome to this edition of your coding, Fast Facts. My name is Theresa Duncan with Odyssey Management, and I am here to talk to you about D4999, which is what I'm going to use for my laser disinfection. I get this question all the time. Is there a laser disinfection code? And at this moment in time and for 2023, it's not on the horizon either. For 2023, there is no code for laser disinfection. So we have to use what is available to us, which is a D4999, the miscellaneous in the periodontal category.
Now, what we're going to do with the laser disinfection is we're going to make sure that it's noted in the clinical notes what you did, what is encompassed in that. And so there has to be some verbiage in the clinical documentation that you actually did do this. Now, will it be covered? Let's talk about that. Yes and no. So if you are a contracted provider, you are most likely going to see this not being covered and you may or may not be asked to write it off. And so therefore, you're going to have to really think about this type of pricing and the cost of your practice and what's good for the patient because what I've heard from offices is that the amount, if they have to write off laser disinfection, then it actually is cost prohibitive for them to provide the services if they take a look at their cost per procedure services. Now, that may or may not be the case for you, so you're going to have to double-check with your admin team and your doctor about that. But we do need to have it noted in the chart. If you do perform it, we do need to have it noted everything that goes along with laser documentation. And as you know, if you're doing lasers, you have a lot of documentation, you have tips, you have wavelengths, you have all sorts of stuff there. There has to be something in there about the disinfection.
So typically, though, because it is considered to be part of the overall procedure, insurance carriers use that as a reason to not cover it. But unfortunately, the ADA and the coding committee stands behind that and considers disinfection to be part of the procedure, which is just a little mind boggling for me because as you know, it's totally different. So what you're going to do with D4999 is make peace with the fact that any nine nine nine code, miscellaneous codes, are just not going to get paid.
It's very rare to get paid for any code ending in 999. Typically, you're going to send in the clinical notes that's going to be your report. You're going to send in all sorts of documentation and it's probably still going to come back denied. But here's what's interesting. When you send in for the scaling and root planing, if you just have that blurb in your clinical notes about the need for disinfection and what is the expected outcome of the disinfection, then that's going to be enough to cover the 4999 code. So you're going to submit for scaling root planing, you're going to submit for the 4999. And your one clinical note should encompass enough for all of those codes. So try not to separate this out. Just go ahead and send it in all at one time because you've got all the documentation together. Your admin team is going to send one claim with all the radiographs and the clinical notes together. Okay? So it's just easier to send it all on one claim, especially because it's all going to be looked at at the same time.
Now let me just speak very quickly about a denial versus a disallow. So a denial is if they decide to not cover the procedure, but they're going to allow you to bill a patient. That's a denial. A disallow is when they decide not to pay for it, but they also aren't going to let you charge the patient. And unfortunately, if you're a contracted provider, you may run into this and your admin team is not going to be happy. And if you're paying on collections, you're not going to be happy. So what you'll need to do is make sure your admin team keeps an eye out for this and sees whether or not that's a situation and then have a conversation around that and what to do. I have been seeing that offices are taking advice to create an internal code and that's not going to help you get around the disallow. And I wish that I could find out where it's coming from, but it's really bad information. So what I'm seeing, and it's happened enough that I need to caution you about it, is you would come up with your own internal code, such as 4998. Okay? So there is no dental code. 4998. So you would use 4998 in your office. It would be billed out to the patient and the patient would just see that it's not covered by insurance and they would pay it. But had you submitted it under the proper code, it would have been processed according to the plan's design.
Now when you come up with a fake code and there is a more appropriate code that already exists, you're actually not doing the right thing here. When using the code set, you are to use the code that is the most appropriate by the description. And if no description fits, then you go to 4999. So there is a loophole there where if there's nothing that fits, you go to 4999. Doing a dummy code for the purposes of getting reimbursed is actually, I don't want to go too much into it, but it's a little bit of deception and so it could be counted as fraud because there's motive behind it. So fraud always has an element of motive. And so insurance carriers, if they were to audit you and you're using a code regularly because you know it's not going to get covered, so you came up with this code, you're going to have a hard time passing that audit. And I guarantee you, because I've seen it in 20 plus offices already. I've seen it where they have to refund the money back to the patient because they were found to have been basically playing fast and loose with the code interpretation. So don't be that office if it doesn't work for you, if the numbers don't work for you, as far as being profitable, then you need to have a conversation about whether or not it's profitable to be on that plan or to offer that service. And so it should never go into, how do we get around this? So anytime you start to ask yourself questions like, how do we get around this? Or how can I build this differently so I can get paid, understand that by asking those questions, you're going down a path that is a shady path. And I don't want you to end up being one of the 20 plus offices that I have talked with and had to counsel through audits. I don't like audits. I hate them for you, and I don't want you to be involved in them. And using a code that's not intended accurately is a good way to get put onto a radar.
So I'll get off my soapbox now and end by saying that laser disinfection is absolutely an important part of the procedure. It really is a shame that it's not been recognized to have its own procedure code. But as time goes on, as technology evolves, as the coding committee evolves, and has new members going in and out, perhaps we'll see that approved down the road. But for 2022 and 2023, it's not in the cards for those two years. All right, so until the next edition of Coding Fast Facts, feel free to check out my website, Odysseymgmt.com. That's Odysseymgmt.com. And again. My name is Teresa Duncan. We'll talk to you soon.
Thank you for listening to another episode of Fast Facts - Coding Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at www.dentistrx.com. We'll see you next week for another Fast Fact!