May 2011

HDS Holiday Memorial Day Monday, May 30

HDS Online and DenTel will be available.

Save Money with the Discounts for Dentist program!

Save money from a variety of vendors offering discounted rates and special offers for a variety of technology and office support services. The discounts are available to you just for being an HDS participating dentist. Log on to HDS Online to download a copy of the packet or call Professional Relations to request a packet. Visit HDS Online to Download Forms to: • Add a new

location

• Add or terminate HDS Online users

• Sign up for Direct Deposit

• Inactivate a dentist from a location

Information

Eligibility and Claims: Customer Service Monday - Friday 7:30 a.m. to 4:30 p.m. Oahu: 529-9248 Toll Free: (800) 232-2533 ext.248

HDS Participates in 6th Annual Wai’anae Coast Keiki Spring Fest More than 700 children along with their parents visited the HDS booth at the sixth annual Wai’anae Coast Keiki Spring Fest on April 8 at Waianae District Park. HDS, along with Dr. Dan Fujii, dental director at Waianae Coast Comprehensive Health Center, and his resident dentists provided oral screenings to nearly 200 children during the four-hour fair. Mahalo to Dr. Fujii and his resident dentists: Jon Fu, DDS; Gerald Lee, DDS; Kunjan Patel, DDS and Nakako Uritani, DDS.

From left: HDS staff in maroon shirts: Jessie Barroga, Shere Saneishi-Kim, Holly Shea, Lani Abrigana, Stephanie Liu-Antonio; Resident Dentists, Nakako Uritani, DDS, Jon Fu, DDS and Dan Fujii, DDS.

Resident dentist Kunjan Patel Resident dentist Gerald Lee

Got New Staff? Get Free Training At Your Office

• New Staff Orientation: HDS offers basic training for front office staff who are new to the dental industry. This one-hour training session is designed especially for dental staff who do not have experience filing dental insurance claims. A review on how to use HDS’s Procedure Code Guidelines will also be covered.

• HDS Online and HDScan Training: HDS offers training on our HDS electronic tools. We will show your office staff how to verify patient eligibility, check patient history, and submit claims via HDS Online. They will also learn to send traditional X-ray films, digital X-rays and other attachment types in a JPEG format or by using HDScan, our free scanning software to help simplify your scanning process.

The sessions are free and are held at your dental office. Please call Professional Relations at 529-9222 or toll-free at 1-800-232-2533 ext. 222 to schedule a convenient training time.

Ask HDS If you would like to submit a question, please e-mail us at askhds@hdsonline.org. Q: Should I submit my Type 2 Organizational Number to HDS? A: Yes! Please provide us with your number so we can update our database and the National Provider Database for all Delta Dental plans. Q: What number should I include in Box #58 on the 2006 ADA form? A: Box 58: Treating Dentist and Treatment Location Information should contain the treating dentist’s HDS filing number. If you do not know your filing number, please contact Customer Service.

New Group PWC Corporation - #2927

New Participating Dentists General Practitioner William C.W. Li, DDS Honolulu, Oahu Endodontist Rachel M. Yorita, DDS Honolulu & Aiea, Oahu Retired Dentist Randall T. Yoshida, DMD

Take Advantage of HDS’s Eligibility Guarantee

HDS’s Eligibility Guarantee is available to you to guarantee your patient’s eligibility even if the patient is retroactively terminated from his or her dental plan. HDS guarantees the eligibility of the patient if the dental office has verified eligibility and obtained an Eligibility Verification form on the date of service through HDS Online or DenTel. The Eligibility Verification form can be printed from HDS Online or requested as a fax back through DenTel. HDS is the only Delta Dental plan to offer this guarantee.

The following conditions apply to the Eligibility Guarantee: 1. The dental office must provide a copy of the Eligibility Verification

obtained through HDS Online or DenTel on the date of service. Phone calls to Customer Service will not guarantee eligibility.

2. The claim must be submitted within seven calendar days from the date of service.

3. The guarantee does not apply to more than one HDS plan. If eligibil-ity was verified for more than one HDS plan and upon processing of the claim, only one coverage is active, HDS will process the claim under the active coverage only.

4. In the case where eligibility was verified for more than one HDS plan and upon processing of the claim no coverage is active, HDS will process the claim under the former primary plan only.

5. Only eligibility is subject to this guarantee. Plan maximums, frequencies and other limitations will be subject to the usual HDS claims adjudication guidelines.

HDS OnlineTips:

Use Hot Keys! By using the ten key number pad on your keyboard, you can quickly navigate to these various fields during claim submission with the following five Hot Keys: [ . ] Takes you to the next field (like Tab) [ - ] Takes you to the previous field (like Shift Tab) [+ ] Jumps to the procedure code box on the next line [ / ] Jumps to the procedure code box on previous line [ * ] Validates the claim

Understanding Health Care Reform

In 2010 President Obama signed into law a health care reform bill passed by both the House and Senate. HDS is following every step of the health care reform implementation process, from the development of exchanges to the formulation of plan designs. When it comes to the full implementation of health care reform legislation, many questions remain unanswered. However, we do know a few details. For instance, stand-alone dental plans are generally exempt from the insurance market reforms. On the other hand, we know that access to some level of dental coverage for children will be nearly universal by 2014. Individuals and small businesses will have access to pediatric dental plans through newly developed insurance exchanges, as well as in the commercial market, and those individuals meeting certain income requirements will have access to subsidies. But at this time, no one knows what the required pediatric dental benefit will look like. Congress recognized that when it comes to health insurance, dental is different. Ninety-seven percent of dental policies are written separately from medical. The preventive nature of dental benefits coupled with flexi-ble plan designs has served patients well. Regardless of the outcome of health care reform, HDS will continue to offer quality dental coverage both inside and outside the exchanges.

Consultant’s Corner Robert G. Sherman, DMD Diplomate, American Board of Oral Medicine Dental Director, Hawaii Dental Service (HDS)

This article reviews the CDT nomenclature and descriptors for misreported or misunderstood codes that are frequently submitted to HDS. It also contains additional information to assist the office in making a correct CDT procedure code selection.

D2950 core buildup, including any pins The current CDT 1 descriptor of a core buildup (D2950) states “refers to building up of anatomical crown when a restorative crown will be placed. A material is placed in the tooth preparation for a crown when there is insufficient tooth strength and retention for the crown procedure. This should not be reported when the procedure only involves a filler to eliminate undercut, box form or concave irregularity in the preparation.” For benefit purposes, HDS plans utilize Christenson’s criteria 3 of more than 50 percent of the remaining pre-pared coronal tooth structure to be missing or damaged due to caries or fractures such that the strength and retention of the crown is compromised or when there is not at least a 2-3 millimeter collar of sound remaining tooth structure at the gingival aspect. Many dental offices mistakenly believe that the replacement of a filling in a tooth planned for a crown constitutes a core buildup. See example below.

D8210 Removable appliance therapy HDS benefit plans with orthodontic coverage include a benefit for D8210. The CDT1 descriptor for D8210 states “Removable indicates patient can remove; includes appliances for thumb sucking and tongue thrusting.” The submission of D8210 for treatment of bruxism or when a “night guard” has been fabricated is an incorrect use of this code. The appropriate code for night guards and bruxism treatment is D9940 which is not a benefit of most HDS benefit plans. The D9940 CDT1 descriptor states “Removable dental appliances, which are designed to minimize the effects of bruxism (grinding) and other occlusal factors.”

# 31 submitted for D2950 core buildup with no accompanying narrative. No obvious interproximal decay or cuspal fractures are noted. Retention for a crown does not appear to be compromised or inadequate. This D2950 buildup was disallowed.

Tooth # 19 submitted for onlay with core buildup D2950. After proper occlusal and interproximal tooth reduction, it does not appear to meet criteria for a core buildup D2950 but is a “filler” for remaining box forms or concavities. The core buildup was disallowed.

Teeth # 12, 13 submitted for payment as D2950 core buildups. It appears the treating dentist has simply replaced prior MOD amalgam restorations.

D9940 occlusal guard, by report

The CDT1 descriptor for D9940 states”Removable dental appliances, which are designed to minimize the effects of bruxism (grinding) and other occlusal factors.” While most dental plans may not have the occlusal guard or “night guard” as a covered service, certain orthodontic appliances (D8210 removable appliance therapy) designed “to control harmful habits” may be a benefit in those plans with orthodontic coverage. The D8210 CDT 1 descriptor states” Removable indicates patient can remove; includes appliances for thumb sucking and tongue thrusting.” The submission of D8210 removable appliance therapy for treatment of bruxism or when a “night guard” has been fabricated is an incorrect use of this code.

D7286 biopsy of oral tissue-soft

The current D7286 CDT1 descriptor states “For surgical removal of an architecturally intact specimen only. This code is not to be used at the same time as codes for apicoectomy/periradicular curettage.” For benefit and payment purposes, a pathology report is required in HDS dental plans. In numerous instances, HDS general practitioners have removed tissue but subsequently discarded the biopsy specimen which never was submitted for histopathology evaluation. Unfortunately, in this circumstance, the patient never receives an accurate clinical and histologic diagnosis since the dentist never submitted the specimen for microscopic evaluation. Failure to submit for appropriate microscopic evaluation and obtaining the required pathology report may result in no payment by HDS.

Upcoding and/or unbundling of this code may occur when an office has submitted a claim for payment for the removal of periradicular granulation tissue in conjunction with an extraction of a non-vital or endodontically treated tooth with a periradicular radiolucency (considered part of the extraction). Procedure code D7410 excision of benign lesion has been improperly submitted on multiple occasions for periapical granulation tissue scrapings. In several instances, I have also noted claims in which providers have completed a brush biopsy-transepithelial sample collection D7288 yet incorrectly submitted as a surgical biopsy using the D7286 code (See example above) It is vital that dentists and office mangers have a clear understanding of the CDT code and the need for accurate coding and claims submissions. Improper coding whether intentional or unintentional may have negative financial implications for the patient, subscriber, employer group, other network dentists, as well as the dental plan. References: 1. CDT 2011-2012: The ADA Practical Guide to Dental Procedure Codes. American Dental Association, 2010 2. Christensen G J: “Building Up Tooth Preparations for Crowns-2000”;JADA, Vol 131, April 2000. 505-506