Happy Summer!  It’s finally here!  My gosh this year is just flying by.  I am sure as you are reading this you are already feeling the busyness of summer in your practices. 

We had a really productive spring here with lots of on site client visits (which I love) and a two day workshop where we had people attend from many states (Georgia, Iowa, Maryland, Massachusetts, Nebraska, New Hampshire, New York, North Carolina, Oklahoma, Rhode Island, Texas and Utah).  We spent two days discussing coding, billing, reimbursement and the accounts receivable cycle from start to finish.  It was amazing!  There was lots of learning and sharing by all.  If you were not able to attend this time, I hope you will join us for the next.

 

In the meantime, there are a few changes and updates in the insurance industry I want you to be aware of (in case you have not heard).  The American Dental Association has released a new ADA form for 2019.

According to the ADA: 

The ADA Dental Claim Form was last structurally revised in 2012 to incorporate key data content changes that enables diagnosis code reporting that was also incorporated into the now current version of the HIPAA standard (837D v5010) electronic dental claim. This version of the ADA form incorporates editorial changes to further its consistency with the 837D.

You can download a copy of the new form with complete instructions from this link on the ADA website  https://www.ada.org/en/publications/cdt/ada-dental-claim-form.   I do recommend you download the form and review the instructions on how to complete the form.  Contact your software vendors as well to see when they will have the new forms available for use.

 

Also worth noting is that in January of this year the ADA released a new code of D9613 to report infiltration of sustained release therapeutic drug, single or multiple sites.  This code is used to report for Exparel, which is most commonly used in our industry.  Aetna Dental has developed some specific guidelines on when they will consider coverage and which specific procedures.  The recommendation from Aetna is for offices to contact Aetna in advance to confirm coverage.  D9613 may be reimbursed when used at the time of third molar surgery.  In the remarks section of the claim the word “EXPAREL” must be listed.  This is the most direct guidance I have seen from a carrier related to this medication.  When I hear more I will certainly pass it along.

 

Best wishes to you for a great month!  Happy Father’s Day to all the Dads in our lives and Happy Flag day to all!

 

Until next time, Keep Calm and Code On

TERRI