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October 17, 2022

Anesthesia Billing for Dental Insurance: A Few Things to Know

October 17, 2022

Anesthesia care for dental procedures is a common necessity, owing to the nature of the dental work performed in addition to the general public’s apprehension of it. Dealing with dental and medical insurance, however, can be an unwelcome task on top of the already arduous medical insurance billing despite its prevalence.

Like most things in anesthesia, though, dental insurance can easily be navigated with preparation, documentation, and training. (If you feel like you need more training in dental anesthesia billing codes, we can help!) Despite the challenges in providing this type of care, there are still benefits for your practice to serve this often overlooked market. 

Should you manage your anesthesia billing in-house or outsource? Find out here. 

Ensuring Proper Care

Before you can bill for it, you must ensure that proper care is being provided. Oftentimes, anesthesia care for dental cases is performed in an ambulatory setting which means you lack control over some of the variables that affect patient treatment. There are certain requirements for monitoring patients, recovering patients, and the types of anesthesia agents used in the procedure. If you have any qualms about these when providing services, you must not perform the procedure. Not only could something go wrong, but you would be unable to bill for non-ASA-approved work. 

The American Society of Anesthesiologists has released a statement on the set of standards for providing dental anesthesia care, including specifications for:

  • Anesthesia provider training and education
  • Monitoring and equipment
  • Facilities
  • Patient and case selection
  • Resuscitative measures and protocols
  • Data reporting and transparency

Whether local anesthesia, IV sedation, or general anesthesia, ensure you have followed all of these regulations. 

Anesthesia Billing for Dental Cases

In all dental cases, it’s important to pre-authorize the work that will be performed, document everything, and code properly. Dental anesthesia is recognized by payers, but policies vary by plan, and there are always loopholes. Scheduled dental anesthesia care should always be pre-authorized before the procedure to ensure it’s covered by the patient’s particular plan. Research in preparing a patient’s care plan, as well, because not all drugs can be billed to the patient even if the service can be. 

The typical dental case is worth 10 ASA Units (5 base units x 5 times units). Dental codes should always be billed to the patient’s dental insurance, while ASA codes are billed to the patient’s medical insurance. The CPT code for dental procedures is 41899, but this is a non-specific code - it links to 00170, which is the code for general intraoral procedures. Using code 00170, with your appropriate modifiers, the total time units would cover the professional portion for the anesthesiologist or CRNA. Of course, we can help you navigate all CPT codes - including the dental codes, or D-codes, just reach out to us here.

Bad billing can be costly! Learn more about the dangers of incorrect documentation for anesthesia services. 

Complications & Challenges

While there are many costs to anesthesiologists, when providing dental anesthesia care, only a few of them can be billed to dental insurance, with the rest going to the patient’s medical insurance. The D-codes, as mentioned above, will be billed to dental insurance, with your ASA codes billed to the patient’s medical insurance. When providing general anesthesia for dental procedures, you will often have to prove medical necessity when billing. This can include patients who are typically combative, have special needs, or have severe autism. It can also include young children but typically does not apply in the case of an average, healthy adult. If your anesthesia providers are providing an ambulatory service and have a facility fee, CPT code 41899, this is billed to the medical insurance as well, not the dental plan.

As you can see, there are many essential details to keep track of in this billing process to ensure your anesthesiology group is maximizing cash flow. But the challenges related to anesthesia billing for dental insurance can be avoided by preparing thoroughly, documenting the procedure, and adequately knowing all the correct CPT codes. If you are having trouble with any of the above, our team of experts can assist. Let us know! 

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