What Date do I Use When Submitting Multi-Stage Procedures?
Delta Dental of Kansas (DDKS) General Policies:
Multi-stage procedures are reported and benefited upon completion. The completion date is the date of insertion for removable prosthetic appliances. The completion date for immediate dentures is the date that the remaining teeth are removed and the denture is inserted. The completion date for fixed partial dentures and crowns, onlays and inlays is the cementation date regardless of the type of cement utilized. The completion date for endodontic treatment is the date the canals are permanently filled.
To avoid claim processing delays, we recommend:
- Posting the procedure on the patient ledger and collecting the patient’s estimated co-insurance on the impression date (recall from the handbook, that the patient cannot be charged up front for any amount which is anticipated to be paid by DDKS)
- Printing and holding the claim in a file until seat date
- Submitting the claim following delivery to the patient (in remarks box #35, include completion date to reflect the cementation or delivery date)
Nationally, Delta Dental member companies require that you submit all multi-stage procedures upon delivery. Orthodontic treatment is submitted on the date that brackets are bonded/cemented or the first aligners are delivered.
But What if My Patient Never Returns for Delivery?
You may believe that collecting from the insurance protects you if the patient never returns for their night guard, orthodontic appliance, denture, permanent crown, bridge or other lab-created device, however this is incorrect. If the procedure is never completed, which includes delivery to your patient, any insurance money received toward that procedure must be refunded.
If your patient agrees to services that take more than one appointment or for which you incur a lab bill, but the patient never returns for the final product, then the correct procedure code is the corresponding temporary or interim code - or you may need to use one of the miscellaneous codes. Always include a narrative for these situations.
Delta Dental does not provide coverage for incomplete services, but some temporary services are made patient responsibility depending on circumstances, so be sure to include those on your claim form. If documentation was not included on the original claim, appealing the claim with additional information such as chart notes and/or narrative may allow us to reprocess and deny to patient pay so that you can recoup your lab and material costs from your patient. Sometimes patients change their mind mid-treatment and that is why it is critical that you collect the patient portion on or before the date of impression.