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Rules and Regulations

Ask the Expert ForumCategory: Insurance CodingRules and Regulations
Avatarguestuser Staff asked 3 years ago

Thank you for your information on insurance coding, as it is a very complex world. I am a dental associate in a practice that I do not feel is completely up to date on the rules and regulations behind the periodic, comprehensive, or periodontal exams that occur in conjunction with the hygiene visit. My office bills these exams under the practice ownerÕs name regardless of whether he actually completed the exam or is even in the office. I do not think this is acceptable under our state regulations but I cannot find any evidence against it. Can you help?

1 Answers
Karen Davis, RDH, BSDHKaren Davis, RDH, BSDH Staff answered 11 months ago

I am glad you asked this question as I believe other practices may also be doing this incorrect coding. All diagnostic examination codes require that the dentist perform the patient examination. The dentist may delegate collection and recording of the data to an auxiliary, but diagnosis is the responsibility of the dentist. This is stated in the American Dental Association’s CDT: http://www.ada.org/en/publications/cdt/ as well as Charles Blair’s Coding With Confidence manual: http://www.ada.org/en/publications/ada-dental-product-guide/product-category/product-profile?productid=151&catid=21 You may wish to purchase one of these resources for clear direction in your practice. Thank you for asking!