Medical Billing for Dental Sleep Medicine – Getting Your Ducks in a Row

by Rose Nierman, Nierman Practice Management

Medical billing doesn’t have to be complicated. Dental sleep medicine practitioners can build a successful practice by ensuring they submit accurate codes and documentation to payers. With the right systems and support in place, medical billing for oral appliances becomes more straightforward. At Nierman Practice Management, we are dedicated to educating dental offices, keeping them informed of the latest changes in medical billing practices. Staying informed helps you navigate medical billing and achieve quicker reimbursement.

One update is that Current Procedural Terminology (CPT^®) 2024 removed the time ranges from office visit codes (Evaluation & Management (E/M codes). CPT replaced them with a single total time amount. This time “must be met or exceeded” according to the new descriptors. This change refers to both the new and established visit codes. For example, 99203 had a time range of 30-44 minutes. Now, the provider must meet or exceed 30 minutes of total service time to bill this code by time.

Exciting Updates

Determining office visit time now extends beyond face-to-face interactions. When selecting your code level, include:

1. Preparation for the patient (e.g., reviewing tests)
2. Obtaining and/or reviewing separately obtained medical history
3. Conducting a medically appropriate examination and/or evaluation
4. Counseling and educating the patient, family, or caregiver
5. Ordering medications, tests, or procedures
6. Entering relevant data into software

Preauthorization Reform Continues

Legislative efforts are gearing up on preauthorization. Currently, a bill in Congress mandates 72 hours for an urgent preauthorization request and 7 calendar days for standard requests, optimistically reducing future timeframes for payer decisions when all the needed documentation is in place. Many states have recently set stronger directives for preauthorization. For updates about state mandates, visit your state insurance commissioner’s website or contact us at Nierman Practice Management.

Getting Your Ducks in a Row

To streamline the Dental Sleep Medicine process and help your practice thrive, consider adopting these practices: implement a web-based system for patient registration and history-taking, verify benefits allowing you to establish financial responsibility for oral appliances and send progress reports to coordinating physicians. This will help to simplify the process and maintain effective written communications with physicians to position your practice as the go-to sleep dentist in your area.