Tips for presenting treatment and dental insurance billing for 2025, Part 2

Enhancing our billing systems in 2025 can significantly boost our revenue, profits, and patient trust while increasing treatment acceptance. Implementing correct coding practices can put this financial growth within our reach.

Part 1 of this two-part series discussed treatment estimates, patient responses to treatment estimates, and the importance of updating current dental terminology (CDT) codes in your management software.

Estela Vargas, CRDH.Estela Vargas, CRDH.

In Part 2, I offer some coding strategies necessary for billing and correct claims preparation and submission in the ever-changing dental coding landscape. I provide some examples that demonstrate how the misuse of dental codes can cause turmoil among staff and patients, loss of revenue, and red flags for insurance companies.

Tip No. 1: Don't unbundle codes to gain increased revenue

Unbundling dental codes means billing for individual components of a procedure separately instead of using a single code that encompasses all the steps involved. Examples include charging for anesthesia, incision, and sutures as separate codes during tooth extraction; billing for each x-ray taken during a full-mouth series instead of using a single code for the complete set; or charging for a base material separately from a filling when it's typically included in the restoration code. Reading the code nomenclature and descriptor is imperative to ensure you choose the correct code.

Overbilling, often a result of unbundling, can significantly damage patient trust. It is crucial to understand how to code for what we do and under what circumstances to avoid this and maintain our patients' trust in our ethical billing practices.

Examples of unbundling of codes:

  • Billing separately for pins in a core build-up (D2950) when pins are included in the code descriptor

  • Billing separately for adhesives, bases, or liners in restorations (the code defines these to be included (global) as part of the restoration procedure)

  • Billing separately for occlusal adjustments and other minor adjustments to delivered prosthetics when the service includes routine postdelivery care

  • Billing separately for suture removal as an additional appointment from the surgical extraction visit (which includes suturing and postoperative care)

  • Billing separately for radiographs taken during endodontic services when these services by code include intraoperative radiographs.

Tip No. 2: Don't use the wrong code (misuse) to charge excessive fees

Charging excessive or unreasonable service fees can lead to overbilling, which insurance companies always disallow. Overbilling can damage your practice's reputation and cause financial loss. Ensuring your fees align with industry standards and accurately reflect the services provided is crucial.

An example of misusing a code

The code descriptor is a narrative that defines the nature and intended use of a single procedure code or a group of such codes. In this example, the practice is misusing the code D9910 -- Application of desensitizing medicament.

After preparing a composite filling, the dentist used a desensitizer and billed the dental plan D9910, believing it was the correct code. Additionally, he has used this code during hygiene appointments when treating exposed root surfaces on patients with crowns. He has applied a material similar to silver diamine fluoride to protect these surfaces from recurrent decay.

Similarly, he has billed D9910 on a per-tooth basis rather than per visit, as stated in the code language. The code language states that the D9910 -- Application of desensitizing medication -- includes in-office treatment for root sensitivity, which is typically reported on a per-visit basis for the application of topical fluoride. The code should not be used for bases, liners, or adhesives under restorations. Many insurance plans do not pay for desensitizing medications on the same day as the restorative treatment.

Another example of unbundling and misuse of a code

D9215 -- Local anesthesia for dental procedures is integral to restorative, perio, prosthetics, and surgical procedures. It cannot be billed separately. That is considered overbilling, and insurance will always disallow it. Per the ADA Coding Companion 2024, it can be reported on claims and ledgers. When the doctor is in network, it cannot be charged to the patient.

There are specific scenarios where local anesthesia (D9210) not in conjunction with operative or surgical procedures can be billed and charged to the patient. These include pain management, diagnostic procedures, and unique accommodations for neurodiverse or sensitive patients. Understanding these exceptions is important to avoid overbilling and ensure accurate coding.

  • Pain management: If a patient presents with localized dental pain but no restorative or surgical treatment is performed, administering local anesthesia for diagnostic or therapeutic relief might warrant D9210.

  • Diagnostic procedures: In rare cases, local anesthesia may be required to facilitate diagnostic work, such as radiographs or perio charting in patients with extreme sensitivity or pain.

  • Special accommodations: For neurodiverse or sensitive patients, local anesthesia might be used solely to help them tolerate an intraoral examination or cleaning, provided no restorative or surgical work is performed on them.

Tip No. 3: Don't bill for services that were not performed on the patient

When patients are scheduled in the appointment book, the appointment is often linked to codes for services expected to be performed from a treatment plan or the scheduler's educated choice.

When the charges are posted to the ledger after the appointment, the patient confidently leaves your office. However, their statement tells a different story. Services are billed that the patient never received, often under the guise of administrative errors or coding misinterpretations.

To avoid these errors, confirm treatment in the morning huddle or business meeting. Before posting charges to the ledger, double-check the clinical notes on file or clarify with the clinical staff treating the patient. Before sending insurance claims, double-check that the clinical notes match the services listed on the claim form.

When we have checks and balances with coding, posting, and billing, we have better cash flow and avoid problems with insurance companies and angry patients.

Author's note: If you're looking for more top tips for mastering dental coding and billing, I have more resources available here.

Editor's note: References available upon request.

Estela Vargas, CRDH, is the founder and CEO of Remote Sourcing, a dental insurance billing and revenue recovery service. She is a graduate of Miami Dade College's dental hygiene program. Vargas' extensive background in the clinical arena of dentistry is coupled with her experience as a practice administrator and business executive.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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