According to DDPA 2020 Adult’s Oral Health & Well-Being Survey, “more than 1 in 4 Americans (27%) who’ve bypassed dental care admit they were scared of going to the dentist.” Providing care for patients with dental anxiety requires time and patience. In busy dental offices, this can be a challenge to keep in mind, and even more so when you add dental coding for dental anxiety into the mix. Patients with dental anxiety often require additional chair time. In addition, there are situations where dentists may even be unable to complete same-day treatment. Knowing how to code for your patient’s visit accurately is vital for proper compensation. Let’s take a deeper dive into helping patients with dental anxiety, dental coding tips for dental anxiety, and the tools you need to keep your dental billing anxiety to a minimum.
What is dental anxiety?
Dental anxiety is a fear or stress associated with a dental setting. Oftentimes, patients with dental anxiety fall behind in their dental checkups, miss dental appointments, and/or refuse treatment altogether. Often times a patient’s dental anxiety will prevent same-day treatment, even if it is an emergency. Needles, drills, previous dental traumas, or waiting too long can all be triggers for dental anxiety. If the patient’s anxiety turns into a panic attack, 9 out of 10 times the patient will have to reschedule, creating confusion on how to properly code and bill for the visits.
Helping patients with dental anxiety
A key to helping patients work through dental anxiety is making sure you have scheduled adequate time for the procedure. Remember, you have to take the time to calm their fears first before jumping into any dental procedure, even cleanings. Be patient and thorough when discussing treatment and/or financial arrangements. Try collecting copays beforehand, not only to obtain their commitment but also to provide one less thing to worry about on the day of their appointment.
Anesthesia services are typically used to help patients with dental anxiety complete treatment. Anesthesia services include:
- Local anesthesia and nitrous
- Minimal sedation
- Moderate (Conscious) sedation
- General anesthesia
With the rise in sedation dentistry, many dental practices are contracting with anesthesiologists to provide anesthesia for their patients. This is both a convenience to the practice and a comfort for the patient. Some other practical ways to help patients with dental anxiety are aromatherapy, sound therapy, warm blankets, paraffin wax hand treatments, and – the most rewarding – caring and nurturing conversations.
Dental coding tips for dental anxiety
Here’s a brief rundown of the 2023 CDT codes for anesthesia services from Dental Coding with Confidence 2023:
D9210 – LOCAL ANESTHESIA NOT IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES
D9211 – REGIONAL BLOCK ANESTHESIA
D9212 – TRIGEMINAL DIVISION BLOCK ANESTHESIA
D9215 – LOCAL ANESTHESIA IN CONJUNCTION WITH OPERATIVE OR SURGICAL PROCEDURES
D9219 – EVALUATION FOR MODERATE SEDATION, DEEP SEDATION, OR GENERAL ANESTHESIA
D9222 – DEEP SEDATION/GENERAL ANESTHESIA – FIRST 15 MINUTES
D9223 – DEEP SEDATION/GENERAL ANESTHESIA – EACH SUBSEQUENT 15-MINUTE INCREMENT
D9230 – INHALATION OF NITROUS OXIDE/ANALGESIA, ANXIOLYSIS
D9239 – INTRAVENOUS MODERATE (CONSCIOUS) SEDATION/ANALGESIA – FIRST 15 MINUTES
D9243 – INTRAVENOUS MODERATE (CONSCIOUS) SEDATION/ANALGESIA – EACH SUBSEQUENT 15-MINUTE INCREMENT
D9248 – NON-INTRAVENOUS CONSCIOUS SEDATION
For detailed comments, tips, limitations, guidelines for narratives, and warnings from Dr. Charles Blair and his Advisory Board, grab your copy of Dental Coding with Confidence – available as an ebook now too!
Medical plans typically exclude anesthesia when provided for those procedures not covered by the medical plan. However, there are exceptions to this exclusion that include, but are not limited to, the following:
- Patients with physical or mental conditions for whom dental procedures would not be possible otherwise
- Patients in need of dental care who are extremely uncooperative, fearful, and/or anxious
- Patients for whom local anesthesia is ineffective
- Patients who are medically compromised
Specific modifiers are required when reporting anesthesia CPT codes. These modifiers report the type of physician providing the anesthesia, the condition of the patient, and any special circumstances. Modified 23 (unusual anesthesia) may be reported when anesthesia is needed for a special circumstance that includes but is not limited to:
- A patient who is combative and/or uncooperative
- A patient undergoing dental treatment who experiences extreme dental anxiety
This modifier may be reported in addition to any other anesthesia modifier, including 47 (anesthesia by surgeon). Payors may require documentation supporting medical necessity for anesthesia.
Want more information on medical dental coding for dental anxiety? Medical Dental Cross Coding with Confidence enables dental teams to conquer the complexities of medical claim submission for dental procedures. Learn from easy-to-follow clinical scenarios with cross-coding guidance, and receive step-by-step instructions for completing the CMS-1500 (02-12) medical claim form. Also available as an ebook!
Dental coding scenario for dental anxiety
While every situation is unique, here is an example of how we helped one Practice Booster subscriber bill for an incomplete visit with a patient who suffers from dental anxiety.
Scenario: Patient presents for SRP. The patient had a pano taken, benzocaine topical placed and a total of 2.5 carpules of Lidocaine 2% 1:100k epi given between PSA, MSA, ASA, IA/L, LB and mental for SRP R side as planned.
The patient exhibited signs of severe dental anxiety. We sat with her for 20+ minutes, where we discussed her anxiety and tried to alleviate her symptoms. Patient states she would “like to try again,” however, as soon as the bib, glasses, and suction were in place, she started crying and expressed the need to leave. She refused to speak with the Dr to discuss anxiety/sedation or future appointments, saying she was “just mostly embarrassed and wanted to leave.”
In this scenario, there are no codes to charge just for the office visit or supplies. The two procedures that were delivered can be submitted, those being D0330 panoramic radiographic image and D9210 local anesthesia not in conjunction with operative or surgical procedures. Likely, the pano will be covered by the payor as expected. Submit a narrative with D9210, outlining the circumstances involved for possible coverage. If in-network, D9210 may be denied and becomes the patient’s responsibility, depending on the PPO provider contract. If disallowed by the contracted PPO, then the fee for the procedure must be written off. For non-contracted dentists, fees for D9210 would always be the patient’s responsibility, if denied. Be sure to discuss options for sedation with the patient prior to another appointment.
Dental coding resources
Practice Booster’s Online Code Advisor is the most comprehensive and up-to-date online database of CDT codes available. This powerful web-based search engine provides an in-depth review of all CDT codes to enable dental teams to properly report dental procedures. Plus, as shown above, it is completely searchable, by either code number or by topic, word, or phrase, to maximize the efficiency of your dental billing team.
- Code Advisor’s Warnings, Cautions, and Matches use an innovative Predictive Error CorrectionTM technology, designed to stop coding errors before they happen
- Code Comments provide additional details on the proper use of a given CDT code, and Code Limitations highlight situations where the code may not be applicable
- Coding Tips and Narrative guidelines offer insight into properly reporting CDT codes to gain timely and maximum reimbursement on claims
- Flowcharts and images demonstrate the proper sequencing of procedures with the related coding techniques
- A Practice Booster subscription also includes 6 paper issues of the Insurance Solutions Newsletter each year, plus online access to the past 3 year’s newsletter articles
Dental Coding with Confidence is the industry’s premier CDT coding guide. Comprehensive content includes expert comments about CDT codes, helping dental practices properly code for what they do. This is a must-have for every dental practice!
Arm yourself with the best tools, resources, and training available from Dr. Charles Blair and the Practice Booster team, tailored to maximize legitimate reimbursement and minimize the hassles and exposures to audit risk.