AboutMark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Expert: Mark Bornfeld DDS Date: 7/22/2008 Subject: Difference in resin based composite
Question Hi,
It was discovered that my son needed to have some work done on his teeth. A Pre-Auth was submitted for various codes, 4 of the codes were D2392 (tooth B), D2331 (tooth D) and D2391 x2 (tooth L & S).
After the work was completed I received a bill for D2393 x3 (Tooth B, J, S) and D2332 (Tooth E).
My question would be why the change and would the use for these codes not have been obvious during the exam for the pre auth request and what is the difference in the codes that were submitted for Pre-Auth and the ones that were supposedly performed and billed for of which the Tooth numbers do not match?
Thanks
Answer Dear Opelia,
From your description, the following changes were made between the pre-treatment estimate and the post-treatment billing:
Tooth B: upcoded from D2392 (resin, 2-surface posterior) to D2393 (resin, 3-surface, posterior);
Tooth D: from D2331 (resin, 2-surface anterior) to either being omitted from treatment or upcoded under different tooth designation (tooth E) as D2332 (resin, 3-surface, anterior);
Tooth L: from D2391 (resin, 1-surface posterior) to either being omitted from treatment or upcoded under different tooth designation (tooth J) as D2393 (resin, 3-surface, posterior);
Tooth S: upcoded from D2391 (resin, 1-surface, posterior) to D2393 (resin, 3-surfece, posterior);
Quite obviously, I cannot reliably infer just why your dentist's actual treatment differed so markedly from the pre-treatment estimate. To put the best possible face on it, I will concede the fact that surprises do happen once treatment is initiated-- I have certainly found on occasion that a cavity was more extensive once I started working on it than I had anticipated. However, the fact that not one of the four fillings concluded in the way they were planned means one of three things:
1. your son's dentist is consistently failing to diagnose his patient properly
2. your son's dentist is motivated by something other than just his patient's best interest
3. your son's dentist's clerical staff needs a lot of remedial coaching, because someone is making mistakes.
I'm sure that it did not escape your notice that every procedure code in the pre-treatment estimate was up-coded-- that is, each filling was changed to encompass a greater number of surfaces, and therefore a higher fee was no doubt charged. While the legitimate need to up-code cannot be logically excluded, the general pattern cannot be ignored.
While my preferred posture is to give the benefit of the doubt, I will agree that your suspicions are justified.
Hope this helps...
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
