Beyond delivering quality dental care to patients, dental billing and coding play a crucial role in determining profitability for a practice and boosting cash flow. Insurance billing is governed by CDT codes. CDT codes are always evolving, and the dental team needs to be abreast of the coding landscape in dental care.
The dental team can take advantage of dental billing services that are powered by automation platforms and AI-enabled services. These advancements help the dental billing team to create accurate and compliant claim submissions that help with faster reimbursements. Moreover, they help avoid a commonly occurring error like unbundling.
A common error in billing is unbundling in dental billing, which can create setbacks for a dental practice. This post explains common examples of unbundling in dental billing and offers practical tips to avoid this costly mistake.
If the dental team bills numerous codes for services rendered to a patient that have a single comprehensive code, then it can be considered unbundling in dental billing by the insurance company. It can be safely considered that having separate charges for different service codes would result in a higher amount as compared to a single code that covered the services.
Insurance companies and the American Dental Association regard unbundling as fraud. This is because unbundling leads to overcharging and an increased billing amount. If multiple codes are used by the dental team when a single code is sufficient to cover the treatment rendered, then the claim will be rejected by the insurance company.
A few cases considered as unbundling by the ADA are as follows:
• Code D2950 used for core buildup code already incorporates pins, and hence billing pins as a separate service is not permissible.
• D3310 dental code is meant for root canal therapy or endodontic therapy performed on the anterior teeth. Reporting X-rays and intra-operative X-rays as separate services when they were taken during root canal therapy is not allowed as a separate service. The code already accounts for such X-rays, and hence reporting it separately would be deemed unbundling.
• Different dental codes for extraction also include suture removal and postoperative care. Billing such items as separate services can lead to a claim getting rejected.
A dental claims report compiled in 2023 by AAPC Services indicated a significant volume of unbundling errors. This showcases the necessity of enhancing knowledge and skill when it comes to billing and coding. While reviewing 2,600 claims and 260 providers, the report highlighted an accuracy rate of 79% and nearly 14% of the claims found to have instances of unbundling.
Common errors included unbundling of X-rays or inadequate documentation that supported the need for X-rays or any medical necessity. Commonly misused CDT codes included:
Unbundling cases were found in procedures such as tooth extractions, intraoral placement of a fixation device done within the same time limitation, crowns, protective restoration, etc. The dental team needs to have a solid understanding of evolving codes that can correctly reflect the treatment provided to patients.
Incorrect billing or unbundling in dental billing can have the following impact on dental practices
If the dental team bills a procedure that consists of multiple codes when it could be billed as a single comprehensive service, the insurance company will reject such a claim or may offer only a partial reimbursement. Besides a financial setback and subsequent, such lapses or errors can lead to audits and an increase in documentation, as well as an administrative workload for the dental team.
A claim that is denied requires the dental team to rework the submission, and this can cost the practice additional money and time.
If found to be performed intentionally, unbundling can be deemed fraud, and this can lead to the imposition of steep fines. When unbundling errors are repeated, the practice can lose its reputation and credibility with insurance companies.
There can be instances when the insurance company might make a payment for a claim that has incorrectly used unbundling of services instead of a single code. An insurance company is entitled to a recoupment if the insurance company recognizes the error later.
A few steps that the dental team needs to follow:
The dental team needs to select the relevant and appropriate single code that represents the procedure performed. For performing a comprehensive periodontal evaluation, the applicable code is D0180. The code is applicable for a full-mouth periodontal evaluation. The procedures that can be applied with this code are an assessment of gingival inflammation, charting of pocket depths, and X-rays needed to check bone levels. The dental team needs to use this code to bill the procedure as it covers a periodic oral exam and bitewing X-rays.
Unbundling by using different codes results in the claim getting rejected. By selecting the right comprehensive code, the team ensures compliance and enables prompt reimbursement.
The dental team needs to be adept at understanding and applying CDT codes. The codes are updated annually by the American Dental Association. The dental team needs to be alert about these changes and other evolving guidelines. Using the right codes helps the practice maximize reimbursement and stay compliant.
For example, code D2940, which represents ‘placement of interim direct restoration,’ was changed from protective restoration to placement of interim direct restoration. This was done to streamline the reporting of interim restorations. This code can now be used as a comprehensive code to represent the placement of any restorative material as an interim direct restoration using any method.
More importantly, interim therapeutic restoration served by code D2941 was removed. Hence, keeping abreast of code changes can help in accurate claim submissions.
The dental team needs to acquaint themselves with rules that apply to bundling of services. There might be situations where unbundling under one plan might be permitted under another plan. The ability to navigate the coding landscape will aid in preventing denied claims while ensuring faster reimbursement.
The team must conduct periodic reviews of the billing process. This can help to detect errors and lapses in coding and recognize unbundling instances.
The team needs to cross-check the claims before submission to the insurance companies so that any errors committed due to oversight can be rectified.
Unbundling errors committed by the dental team lead to claim denials and reduced reimbursement. In addition, the practice can face audits or compliance issues. Working with an outsourced specialist is a reliable way to ensure negligible errors and cleaner claim submissions.
Besides faster reimbursements, the billing process can get streamlined. This also helps to keep the practice audit-ready through compliant billing workflows.
Unbundling in dental billing is a common occurrence among many practices. When billing a procedure as different components and billing them separately, instead of a single comprehensive service, an insurance company can reject the claim. An insurance company considers unbundling a form of overbilling. The team needs to thoroughly understand the relevant and applicable codes for all procedures rendered to patients and bill the same as per guidelines.
To know more, talk to Capline Dental or write to info@caplinedentalservices.com
