reimbursement for dental complaints

[Xerxes1729]

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I've heard a variety of things from a variety of people regarding insurance companies and reimbursement for dental complaints in the ED. Things like, "Always diagnose facial pain in addition to dental pain or caries, since they won't pay for a diagnosis of 'dental pain'", or, "Only dentists can get reimbursed for dental blocks."

Does anyone know more than rumors about this stuff, or know of some resource? Obviously, different insurers will have different policies, but there have to be some general guidelines, right?

 

[Birdstrike]

As far as I know, any specialty can still bill and get paid for a nerve block, dental including, if medically appropriate. This is a problem in some specialties with untrained, non-board certified doctors doing and getting paid for procedures they have questionable (if any) training in. Keeping track of who is/isn't boarded, did/didn't do residency/fellowship in a specialty and what procedures are in/not in the scope of different specialties would be nearly impossible for insurance companies, with all the different practice variations and gray areas and overlap in specialties.

As far as ICD 9 codes, the insurance companies do play games where they'll pay for one code and not another. In general, the more specific or potentially applicable icd 9 codes you attach, the more likely you are to get paid on the right one. But they play these games, change these rules constantly, and each insurance company has different rules, so it's very hard to keep up with, even for coding and billing specialists. Go to one of their forums once in a while. They ask the same questions of each other, as the rules are so vague and ever-changing. It's near criminal what these insurance companies do to get out of paying their bills.