Tom Limoli Jr.
Traditionally, third-party payers have contractually reimbursed dentists for only completed procedures. They did not reimburse for individual subcomponents or techniques required to complete the global procedure. As an example, with all bonded restorations, the bonding is nothing more than the technique used to complete the procedure. As such, the technique-sensitive procedures are simply coded as the completed procedure.
I do not recommend separate fees for bonded and nonbonded restorations. When taking into consideration the usual fee for the completed procedure, examine the number of bonded and nonbonded restorations you routinely perform. The single fee should address both restorative techniques equally. The additional cost of the bonding agent is reflected in your total fee charged for the restoration.
According to previous versions of the American Dental Association's Current Dental Terminology, "Local anesthesia is considered to be part of restorative procedures."
Well, guess what? All this is getting ready to change! CDT-2005 will state that local anesthesia usually is considered part of the procedure.
Much has already been written about evidence-based dentistry and its associated parameters of care. For those just now returning from Mars, evidence-based parameters of care are nothing more than the scientific analysis of when you do what you do compared to how you do it ... if you actually do anything. Or, to put it more simply, are we doing the appropriate treatment at the appropriate sequential time for the specific needs of an individual patient?
Parameters of care are very different. Many say they should not be confused with or influenced by a benefit plan's parameters of payment. This two-lane road moves in both directions as parameters of payment should not govern or direct parameters of care.
Why?
A benefit plan's parameters of payment are influenced primarily by the strength of the plan purchaser's almighty dollar. The more the purchaser pays for a plan, the richer the benefits available to the enrollees. High dollar plans have high dollar benefits. Conversely, low dollar plans don't have a whole lot of covered benefits.
The recent articles which have graced the pages of dental periodicals and journals are praising organized dentistry's attempt to nickel and dime the American consumer by giving dentists what they feel they really want: more codes which bring in more money from the evil, blood-sucking insurance companies. After all, look at all the neat codes the physicians have at their disposal! If we have more codes, look at how much more money we can make. Look at how misguided the few are that lead the many down the road to ruin.
Compare the wonders of the two-edged sword with the media's fascination with the "extreme makeover" concept. Only a few are guided by the shallow vanity, while the many fear the overall repercussions when the patients finally realize, down the road, that they are the same emotional patients they were prior to investing thousands for their silken veils of empty happiness.
Will dentists across America now begin charging separately for what they know is part of a completed procedure? Are they going to start charging based on the technique? Will the third-party payers be forced to address the separate charge or simply allow insured patients to fall victim to a lack of fiduciary accountability and responsibility? Do the insurers deny the charge and let dentists collect these fees from the patient, or do payers disallow the charge and reduce reimbursement for the completed procedure in order to address the fee for local anesthesia?
I think not. All will be well. We don't need to throw out the baby with the bath water just yet. I don't think the bulk of America's dentists are going to abuse their patient base. Yes, there will be the greedy few. But then again, isn't the enemy of our enemy really our best friend?
Tom Limoli Jr. is the president of Atlanta Dental Consultants and the editor of Dental Insurance Today, a bimonthly publication that addresses third-party reimbursement in the dental office. He also is the author of Dental Insurance and Reimbursement Coding and Claim Submission. He can be contacted by phone at (404) 252-7808. Visit his Web site at www.LIMOLI.com.
