Million Dollar PPO Coaching and Consulting helps offices achieve both administrative and clinical efficiency in order to maximize profitability in the modern era of PPO practice. Technology alone cannot create efficiency. However, when different levels of technology are combined with sound systems and solid teamwork, a practice can move beyond the basics to a level far more successful.
As advances in equipment and technology progress rapidly, we are often confronted as coaches, consultants, and trainers with the very real issue of CAD/CAM integration and utilization in the PPO environment. The incorporation of E4D into any practice can significantly improve both clinical and administrative efficiency. While clinical skills are to be learned at E4D University, and through experience and mentoring, integration and coding issues often need to be learned through coaching.
As part of our programs, we include a special module on CAD/CAM (E4D) integration. A large part of this curriculum is spent working on scheduling, and another spent on insurance submission and coding. There are several coding changes that offices often see after E4D incorporation. As an office gains the ability to provide single-visit dentistry, several clinical variations occur that create the need for an understanding and system for submission of new codes, and of codes that were unlikely to have been submitted for the same date of service (DOS).
Ceramic inlays and onlays are infrequently used in traditional restorative environments, but are very common in E4D practices. Not only do CAD restorations offer improved strength and durability over resin restorations, but also they increase production per hour. Direct restorative dentistry, especially composite resin restorations, are labor intense, highly technique-sensitive, and lower in fee than indirect restorations.
As E4D offers the opportunity for a dentist to fabricate and deliver a crown in one single visit, the combination of root canal therapy and the definitive restoration becomes a viable and highly profitable option. However, few offices are prepared for the challenges faced when submitting RCT and crown with the same DOS.
In most of the offices that we work with, the most popular prosthetic code submitted is 2750, PFM. Once an office incorporates E4D into the practice, 2740 becomes more commonly submitted. With that change comes additional challenges including materials issues and documentation. Here is a list of codes and helpful hints to improve the submission and approval process:
- 2620/2630, Inlay. Inlays are rarely covered. Submit not only a narrative based on the clinical research supporting improved longevity of indirect vs. direct restorations, but also pre-operative, intra-operative, and post-operative photos of the restored tooth/teeth. We recommend that when providing an insurance estimate for your financial arrangement, you assume that the inlay will always be downgraded to the corresponding direct resin (2392/2393/), or in some cases amalgam (2150/2160/). Base your financial arrangement on the lowest reimbursement to allow for the fewest financial conflicts.
- 2643/2644, Onlay. Dr. Matthew Krieger is CEO and founder of Million Dollar PPO, a dental practice consulting and coaching company serving dentists across the United States. Its core philosophy is increasing profitability through increasing efficiency. It works with its clients through various programs to ensure that they have the understanding and the tools to create the practice that they’ve always dreamed of.
- 2740, All Ceramic Crown. Once again, submits not only X-rays, but also photos. In addition, assume that the all-ceramic restoration will be downgraded to either of the PFM codes 2750 or 2752. This can be determined during an effective insurance verification call. Always underestimate insurance reimbursements to reduce financial challenges. When you submit the 3310, 3320, or 3330 codes with the same DOS as the 2740 code, be sure to notify the insurance company that the DOS was both the preparation and insertion date. Mentioning that you are a CAD/CAM dentist in the narrative helps to explain the same day service.
There has also been some debate over the recently release 3M Lava Ultimate blocks. As these blocks are a hybrid material (ceramic and resin), there were initially questions regarding a dentist’s ability to submit inlays, onlays, and crowns as ceramic restorations if this material was used. The ADA and 3M have concluded through detailed discussion and debate that restorations using Lava Ultimate should be coded as ceramic.
In all cases, proper insurance verification, documentation, communication, diagnosis, and data collection are critical in properly coding and submitting the appropriate insurance codes. A solid technology platform helps to streamline this process, and maximize success in the insurance game.
For information on how our programs can help you with coding and technology issues, visit www.milliondollarppo.com. For information on the latest in dental equipment and technology, visit www.henryschein.com or ask you Henry Schein field sales consultant.
Dr. Matthew Krieger is CEO and founder of Million Dollar PPO, a dental practice consulting and coaching company serving dentists across the United States. Its core philosophy is increasing profitability through increasing efficiency. It works with its clients through various programs to ensure that they have the understanding and the tools to create the practice that they’ve always dreamed of.
