Hi davidkerr!

Great question. The answer is: it depends!!

This will depend on a few things:

1) The patient's insurance (every insurance company holds their own medical policies for services that are covered and non-covered and why)

2) The nature of the incident and diagnoses assigned

For example - here is a link to Aetna's medical policy "Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans":

http://www.aetna.com/cpb/medical/data/1_99/0082.html

And also, a link to Aetna's policy on "Dental in Nature Oral Surgery: which provides a list of the commonly billed dental in nature services:


https://www.aetnadental.com/i/D/DentalInNature.pdf


As for what types of codes, and good place to look will be the oral/surgery implant visit/form in your DentalWriter software. There is an array of diagnosis code to choose from depending on the specific situation with this patient. For example, you may use:

521.81 = Cracked Tooth

As far as the procedure code - many insurers will accept the appropriate "D" code for these procedures, as many time there is not a specific medical code that describes the service! For example, in Aetna's medical policy above, the following codes are listed as covered if criteria are met:

D4210-D4261, D4268, D4274 = Dental procedures, surgical services (including usual postoperative care)

D7210-D7251 = Dental procedures, surgical extractions (includes local anesthesia, suturing, if needed, and routine postoperative care)

As far as whether or not a referral will be needed - that will also depend on the patient's insurance policy! Some policies will require a direct referral for these, some will not. Also - you will want to call and perform a benefit verification prior to beginning services to check on deductible, coinsurance, whether referral is needed, and whether or not a pre-authorization is needed. It is also important to confirm that the patient's policy has out of network benefits available if you are an out of network provider with that medical insurer. You can ask about the GAP exception/network deficiency at that time as well if you wish!

Hope this helps, please feel free to contact us with any further questions!