The Dental Billing Podcast
Dental billing is not data entry. It's the difference between a practice that collects what it earned and one that writes it off and calls it the cost of doing business.
The Dental Billing Podcast is hosted by Ericka Aguilar and Jen Lyman, RDH. Ericka has been a dental biller since 1998 and has taught billing in 31 states and Mexico. Jen came out of the operatory and now runs Lyman Revenue Solutions, handling both dental and medical billing. One of us knows exactly what the carrier is going to do with your claim. The other one knows what actually happened in that chair. You get both.
Every week we break down denials, appeals, coding, and the carrier behavior nobody warns you about, in plain language, with real sources. We teach the law before the codes, because a code doesn't win an appeal. Knowing what that carrier is legally required to do wins the appeal.
If you've ever been told you're "just the biller," this show is for you. Downloads in 114 countries and counting. Bring your coffee and your worst denial.
The Dental Billing Podcast
Medical Billing For Wisdom Teeth - with Jennifer Lyman RDH
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Your medical insurance may be able to cover wisdom teeth extractions, and the reason most people never find out is painfully simple: nobody asks the right way. We sit down with Jen from Hygiene Unlocked and unpack a real, recent moment where a medical insurance rep insisted “that’s dental” until Jen pushed for an actual code check. Once the CPT and diagnosis pairing was reviewed, the answer changed, and so did the entire cost picture.
We get practical about dental medical billing: how to think in medical necessity instead of “dental vs medical”, how ICD-10 diagnosis codes tell the story that justifies treatment, and why cross-coding matters when an oral surgery plan only lists dental codes. We also talk about the everyday realities of calling payers, including how reps default to in-network benefits, how to confirm out-of-network coverage, and why you should always get a call reference number so you can appeal bad information later.
The takeaway is bigger than wisdom teeth. When we treat the mouth like it’s separate from the body, patients lose benefits they pay for and offices miss legitimate reimbursement. If you want a clearer, more defensible process for wisdom teeth extraction billing, CPT coding, ICD-10 documentation, and CMS-1500 claims, this conversation will change how you look at your next treatment plan. Subscribe, share this with a biller or office manager, and leave a review with your biggest medical billing question.
Registration Link for Diagnosis Codes on a Dental Claim Form Webinar:
https://dentiqhub-diagnosis-codes.vercel.app/
Get your Dental Billing Toolkit Here:
https://www.dentalbillingdoneright.com/the-dental-billing-toolkit
Download "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:
Schedule a billing chat with Ericka:
https://calendly.com/ericka-dentalbillingdoneright/30min
Email Ericka:
ericka@dentalbillingdoneright.com
Email Jen:
jen@dentalbillingdoneright.com
Welcome And Format Change
SPEAKER_00Welcome back to another episode of the Dental Villing Podcast. Jen, I'm so happy to have you back.
SPEAKER_02Hello.
SPEAKER_00Today we're going to do something different, something that I'm really looking forward to is Jen is going to have her first solo episode, and I'm excited to just be a listener.
SPEAKER_02This is going to be different for you, huh?
SPEAKER_00It is different. It's different for the listeners. You know, we my listeners know who you are. I mean, every when I get an opportunity to speak to a listener, I just told you recently I spoke with Alex. Shout out to Alex, and she was like, You know Hygiene Unlocked? I was like, of course I know hygiene unlocked. That's Jen. So, Jen, you have an interesting topic today. You're we're talking about wisdom teeth and medical billing, and you discovered some things that you feel the listeners should know about. So I'm gonna go ahead and let you take it away.
SPEAKER_02Okay. All right. So today we're gonna get into something that honestly most offices should be doing, but most truly aren't. And that's
Why Wisdom Teeth Belong On Medical
SPEAKER_02billing wisdom teeth extractions to medical insurance. This actually came up from a real personal experience that I had recently. And as a biller, you know, I go through this too with my offices, but this was it was made personal the other day when I called my own medical insurance. So my husband needed his wisdom teeth out. And when I called dental, they were only caught covering a small portion. You know, I like to know my own coverage. So I wanted to look into that. And I thought, let me call my medical and see what's possible there. And what happened on that call is exactly what we're gonna be talking about today. I called my medical insurance company and I asked about my coverage for wisdom teeth extractions. And when I called the rep, it was so funny. She was like, This is not the dental department. And I said, Yeah, I know. And she goes, Well, that's dental. We don't cover that. And I just kept sticking with it and being persistent. And the rep like just kept shutting me down one thing after the next. I stayed on the call
Calling Medical Insurance As A Patient
SPEAKER_02and I said, you know, at some point, I said, Can you please just at least check the codes that I want to use? And it was 41899 and you know, the other dental procedures. And she kept arguing with me and kept arguing with me. I said, Can you please just check the code? Check the cross-coding. I have the diagnosis code, I have the CPT code. Can you please just check? She argued with me for like a good five minutes before finally agreeing to look at it. I gave her the code, and that's when, like, honestly, everything changed. Her tone changed, her demeanor changed. She put me on hold for like five minutes. And she finally pulled it up. She pauses and she goes, Oh, that actually is covered. And then she went into this whole story about how, you know, she wishes that this would have been covered for her kids and how she wished she would have known about it. So, anyways, it's something I'll never forget because she told me that I really should be teaching people about this, and that's probably why we're here today. Brian Erica.
SPEAKER_00Exactly why we're here today. Um I was fascinated that the rep didn't know. And I just did a podcast episode about like, excuse me, A players, B players, and C billers. And it's the A billers, the the A players that really push the status quo, and you know, like you did. And you're like, no, I I want to know what the coverage is. And I don't think a lot of billers would have been that persistent. Yeah.
SPEAKER_02Yeah. When I think about people that don't know billing
Pushback From The Rep
SPEAKER_02and just assume that the office is doing their due diligence to look this up. And it's that's not always the case. So I think, you know, even if you're not in billing, you know, if the listeners are not in billing, it's important to know this for your own teenagers, your own spouses and cousins and brothers and whatever, so that you can help them get these things covered because a lot of people just don't know, and then they're missing out on benefits that they're paying for.
SPEAKER_00Yeah. Or the office is charging them for services that they shouldn't be paying for. And I think that this just goes to show that as billers, we truly are advocates for our patients. You know, you were advocating for your husband's benefits, obviously. So I think that this is a strong message behind that story that, you know, we really need to push and know our patients' benefits, right? So I love that story. I love that story. So tell us, how did it, how did it turn out? Did the dental office actually bill? Like, how did this, did you have to teach the dental office what to do?
SPEAKER_02Kind of. So, I mean, I think the biggest issue, kind of going back a little bit, but the biggest issue is that medical is not, dental is not seen as medical. And this always like baffles my mind because we've been trained to think, even as consumers, as people who have health insurance and dental insurance, we've been trained to think that teeth and eyes are not medical insurance, but somehow they're connected to our head. Like this is so counterintuitive. It's so close to our brain, so close to our heart, like it is part of our body. I don't understand how people don't see it as medical. So we need to retrain our thinking about that and remember that the mouth is connected to the body, it is part of the whole system. And it's a very cute skewed concept
The Exact Codes That Changed Everything
SPEAKER_02that people think that it's different and it's it's totally separate when really it is so interwoven. And we need to like know what we're talking about so we can educate other people about that and get the benefits that we're paying for. So if you're dealing with, you know, impacted wisdom teeth, infection, falls, cancer treatments that's causing, you know, ulcers or or drug, you know, treatment, like drug full mouth reconstruction because of drug overdoses or things and drug addiction, like there's there's things that we can do for medical that, you know, I get a lot of pushback on my Instagram page, hygiene unlocked and TikTok, where people are like, well, yeah, but it doesn't cover anything. And what they're referring to is it goes to the deductible. But if you're like me, who sometimes needs to use a lot of health insurance this year, right? I've had a few things happen this year, that you know, that going towards the deductible is some coverage and it's some benefit that at least we get something from our medical insurance. So yeah, medical insurance doesn't care that it's a tooth, it just sees it as part of the body. If it, if we have medical necessity, diagnosis, and procedure coding, we can bill it. So that's one thing I think that we need to know what is a medical situation and then what we can do to get that covered. So, yes. I think there's a few steps that needed to go into this. So when I got off that phone call, I was just I was shocked. And she was begging me, she's like, please teach people about this, please teach people. I had no idea.
SPEAKER_00Well, she's speaking from the consumer side, right? Like she's
Mouth Connected To Whole Body
SPEAKER_00as a consumer who feels duped because they she entrusted the office for her kids to know their benefits, and lo and behold, we're not taught that in dentistry. I mean, it's such a taboo concept to say, you know, bill some dental treatment to medical. You know, I'm I'm very familiar with it, being that I did have a company that we only build sleep-related oral appliances for as an alternative to the CPAP. And you and I have had extensive conversations on that. But other than the few of us that know medical billing for dental, there's very little, there's a very small population in dentistry that actually knows medical billing. Like I would say knows it. And I agree with you 100%. Like it's medical necessity, is everything to medical billing. If it's medically necessary, they will pay for it.
SPEAKER_02Yeah, and I think that's the that's the biggest concept is you need a diagnosis. Like that right there is everything. If you can tell a story, and this is how I, you know, help train some people on this is your diagnosis code tells a story. So it tells where you came from and how you got to what you need treatment for. So it's not just one diagnosis. You know, sometimes when we're billing perio, even to medical sometimes, depending on what it's what it's from. Yes. There is different diagnosis codes as you go down the primary, secondary, tertiary diagnosis codes, it tells that story so that you don't need the narrative like you do in dental as much. But a lot of people don't go down that storytelling route. You know, maybe they have period because they had diabetes and then they had cancer treatment and all these different things. That's how the insurance can justify medical necessity. So if there's, you know, impacted teeth, infection, periol, pain, even accidents, car accidents, there's just so much. But if you don't have that really strong diagnosis, medical
Medical Necessity Starts With Diagnosis
SPEAKER_02just won't touch it because they don't see it as medically necessary, like you said.
SPEAKER_00Yeah. So yeah, I I agree with that. You know, I I'm working now in the workers' compensation space. And medical necessity is everything, I think, even more so in the work comp space because they are there. These are industrial injuries, like a back injury, right? You fall off a battery, you have a back injury, and then you end up grinding your teeth at night because you're in so much pain. Now we're is now we're giving a dentist is getting involved in giving them a repositioning device. We call it a nocturnal repositioning device, which is E0486, right? But it gets totally scrutinized. We have to prove medical necessity. Man, if you want to, if you want to learn how to prove medical necessity, go to work in the workers' compensation space. These guys push back so hard, you would think that they well, they do work for the insurance companies, but but yeah, so job not to pay. Yeah, they they do an excellent job on like the they're the the and the judges. That's the worst part is the judges used to be defense attorneys for these insurance companies. We like walk into trial with all the whammies because we're the bad companies. Like, why is it just getting involved in a back-related case? And it's it it makes sense when you like what you said earlier, it's the whole body, right? Like it's not just the back injury, it's like now the whole the jaws being affected because they're in so much pain, they're grinding at night and they can't help it because they're asleep. So yeah, I mean, there's so much in them in the world of medical, but this is absolutely eye-opening to me because the rep didn't know.
SPEAKER_02Yeah. That there's like and she just kept arguing with me. That was the thing that I was just like, I was getting irritated at some point because I'm like, can you at least check? And she's like, I have to transfer you to dental. And I was like, no, you don't. Like, I am going to tell you the codes. I need to you to tell me if it's covered. And I said, I have the diagnosis codes, like I had everything from the oral surgery office. And I was like, I just look at, just look. Like, that's all that I'm asking. If it's not covered, it's not covered, that's fine. But I need you to at least check. And that's what was so baffling to me is she, as a rep, had never heard of it. And it's because people don't ask.
SPEAKER_00Yeah, I I I do agree with you there because nobody's asking. Um and and I think that all stems from the fact that in dental, we don't know.
SPEAKER_02Yeah.
SPEAKER_00Most most fillers don't know that wisdom teeth and and anything that you can essentially prove medical
Telling The Story With ICD-10
SPEAKER_00necessity for it will be covered by medical, but it's a different volume in terms of like telling the story with the diagnosis codes.
SPEAKER_01Yeah.
SPEAKER_00You know, I specifically remember a patient who could not go and get sleep study done at a lab. And so I was pushing for the home sleep study, and his plan didn't want to cover that. So he had recently had open heart surgery. So I had to really go to bat and get that coverage so that he could do home sleep test so that he can get his oral oral appliance because he was claustrophobic and would not wear his CPAP. So it was affecting his, you can see how that was just snowballing on his health. And I just I felt this urgency, but he had issues. He just had open heart surgery. You know, the this whole total body awareness is so important for the dental builders out there, right, Jen? Because yeah, um, you gotta know when to push back. You have and that rep, I just want to add to she needed to just do her job and check the benefits. I mean, honestly, like that that is what you're supposed to be doing, uh, regardless of the code, you know. And then I wanted to ask you, so your husband's benefits, were these out of network? Was that oral surgeon contracted with your plan, or was he out of network?
SPEAKER_02No, they were out of network, yeah, but there was no pre-authorization
Workers Comp Lessons On Scrutiny
SPEAKER_02necessary. So I think that's also where some offices skip steps is they so pre-authorizations are so different in medical versus dental. You know, dental, it just tells you how much they're gonna cover. It doesn't mean that they'll you can do it or not. Right. Medical means, yeah, you can bill it. You can do it and you can bill it, and we will consider payment after that, but they don't tell you how much they're gonna pay. And so pre-authorizations, like knowing the difference between the two is so important. But it was really interesting calling as the consumer rather than as the provider. You know, I had to even like hang up and call back twice because I accidentally pressed provide. Because I'm so used to talking to them like for my offices. But I thought that was that was funny. I'm like, no, dang it, wrong. But calling as a consumer just gave me a whole new whole like opened my eyes to this because I knew the codes, I knew the diagnosis codes, I knew the CPT codes, but not everybody's gonna do that. And you need to get that information. You know, we have a treatment plan from the oral surgery office. It didn't have the medical codes on there. No, it had dental codes. Yeah. And so I had to do my due diligence, know what that cross-coding looked like, and you know, so I could actually build that. And I'm I am working on something right now that's hopefully going to help people build like the top 20 codes with dental cross-coding over to medical.
SPEAKER_01Yeah. So great.
SPEAKER_02Yeah, go follow hygiene and locked, and that will be out in a few weeks. But I want to make sure that it's really comprehensive so it's easy to follow for people so that they can actually look at that and be like, oh, I build this code. This is how I'm gonna contact medical. You know, this is this the diagnosis codes that tell the story. I actually love finding diagnosis codes too. I'm like one of those weirdos. I'm like, okay, they fell. Let's let's find the diagnosis photo code for a fall and then claustrophobia and let's find that one.
SPEAKER_00Like, oh, I it's just one of my workers' compensation cases. Oh my gosh. You have so fun.
SPEAKER_02Yeah. I'm like, my husband's a cop, and I'm like, you know, and you know in this world that I'm like, I'm like a detective. Like I should get paid as a detective, you know.
SPEAKER_00Well, you and I can go down so many rabbit holes. Like I know. I'm such a fact finder, and I know I think we're both quick starts. So now I'm talking about the Colby assessment. So if any of you haven't taken the Colby, go take it. It's K-O-L-B-E. I think it's 50 bucks to to get your assessment done. But oh my gosh, it's so spot on. I'm what does your husband call me? The idea fairy. You're an idea fairy. Idea, and I am because I am a quick start according to the quote. And quick starts are
Biggest Mistakes Offices Make
SPEAKER_00the idea people.
SPEAKER_02Yes.
SPEAKER_00And so, but the difficult part about it is I'm also a very strong fact finder, which means I have to go verify everything I talk about, like 10 times. So as many. It's a beautiful thing, but man, I can go down some rabbit holes and you are the same. I mean, we can and you can geek out on the diagnosis codes are your thing. Like that is I like to read EOBs for fun. Like I can just sit there and go down.
SPEAKER_02I mean, it's fun.
SPEAKER_00It's a good time. I mean, no wonder why, like, we're always we could just sit here and talk about dental and medical all the things and oh my god. Yeah. Um yeah.
SPEAKER_02But I think there's a lot of like there's a lot of common mistakes that offices make. And I do kind of want to get into that because I think that these, I mean, a lot of these billers are gonna be looking at it and be like, okay, how what do I actually do though? Like, what mistakes are we missing? What can we, what can we do better? And I do want to outline that for people so that they can get at least a a taste of what they could do with insurance. So yeah, so I think one, they assume it's dental only. That is one mistake that that this oral surgeries office did do. They were only gonna bill it to medical, which I do, or only to dental.
SPEAKER_01Dental, yeah.
SPEAKER_02And I do want to outline this, like what that could look like. So for a biller, if let's say we're billing a thousand dollars for an extraction and we bill out the code that is appropriate for that for an extraction, whichever one that may be during that time, whether it's surgical or not. Medical takes that $1,000 and they say, we're gonna pay, you know, our allowable is $800, and we'll we will apply that to the deductible at 80% or whatever. Will say, we're only gonna cover $300 and take 50% of that. So now you're getting $150 of the thousand. So even if you do bill it to medical insurance and it goes towards your deductible, it puts $400 at 50% of their $800 towards a deductible, which is significant. And when you do four, as far as a wisdom teeth, that's $1,200, like towards your deductible. That's a lot of people's deductible already. So I think that argument is already null and void because it there is benefits to it. And going towards your deductible is a benefit. So that argument just needs to be taken out. When they don't use cross-coding, that's another big one. They try to bill only dental codes to medical. You need to know what that cross code is so that it's applicable towards their medical coverage. A lot of them will say they don't cover dental because you have a D in front of it. So know what your cross-coding is. Also, not documenting medical necessity. So why? Diagnosis codes always think why. Why, why, why are we taking these teeth out? What medically is going to happen if we
Out Of Network Benefits And Scripts
SPEAKER_02don't? And they rely on what the rep says without verifying. So without verifying the codes, the specific codes that pair with the diagnosis codes, that's really important verbiage to use is what is the code pairing? Can you check the code pairing for this diagnosis code with this CPT code? So, and honestly, I mean, I I get it. A lot of us were trained within an office or taught in school, and none of this is taught in school either. And so it's one of the biggest, honestly, I think it's one of the biggest revenue miss opportunities in dentistry. Oh, what have you and benefits for patients? Like this is huge.
SPEAKER_00So if I can add to that, yeah, please. When you're calling, this is what I used to experience when you're calling these medical insurance companies, the reps, are they're just very programmed to assume that you're calling for in-network benefits. So you have to emphasize and reiterate like I need out of network. I need to know the benefits for E0486. I need to know the out-of-network benefit for E0486. And then when they tell you what it is, you have to just say, I'm, I just want to confirm this is out of network. And they nine times out of 10, the rep would say, Oh, I'm sorry, that's in network. Let me get that out of network. Because they're just so programmed to give you in network benefits. Because in medical, a lot of dent uh physicians, they just go in network with everyone. That's the way it is in that world. You know, so that's something that if if an office is going to start checking medical benefits, I strongly recommend that you put on your I had a breakdown of benefits sheet just for E0486.
SPEAKER_01Yeah.
SPEAKER_00And I had a script for my reps and at the top that said exactly that. I'm calling to get out of network benefits for E0486 because they would forget. They would say, Yeah, I'm just trying to get benefits for E0486. Rep thinks you're calling for in-network benefits.
SPEAKER_02Mm-hmm. Well, and I even with that most recent phone call, I gave her the NPI of the doctor that I had gotten from the treatment plan. Yeah. And she was like, Oh, I don't have that doctor pulled up. But I'm like, that's because it's a dentist. But like they don't even have the two connected. So she was like, Well, you can't bill, you can't bill for him because he's not, he's not narcissist. And I was like, Oh my gosh. Like it was just one thing after the next. And I was like, no, I can. I know I can. And then by the end of it, she was like profusely apologizing, being like, I'm so sorry. I'm gonna I said, just listen more. Like when somebody calls and they have a question, just listen. And I eventually told her, like, this is what I do for a living. Like, I know what I'm talking about here. And I have had reps where I've asked that same question, you know, this is out of network benefits, and they confirm and always, always, always get a call reference number because I've been able to appeal. If I've gotten benefits and they said it was out of network, I've been able to appeal for the in-network costs because that's what they gave me. So, and I have gotten that overturned twice now.
SPEAKER_00Yeah.
SPEAKER_02So it's really, really important that you ask the right questions, get call permission.
SPEAKER_00Yes, I did that a lot too. When the out of network deductible was like $8,000, I would ask for an in-network exception. And I was given this
Call Reference Numbers And Appeals
SPEAKER_00all the time, even with HSOs, like it was there's if there's no other provider in the area for like 30 to 50 miles or something like that, um, that's in network, which for oral appliance was never the case, we would get that in-network exception so that the patient had, you know, they could take advantage of their $1,000 deductible as opposed to that $8,000 out of network deductible. So I mean, there's so many tricks, but again, you guys, we have to know our, we have to know, right? Like we don't, and that's the that's the problem right there, Jen. That's that's like the crisis. Dental billers don't know what they don't know.
SPEAKER_02Right. Right. And that's where we need to be persistent. And, you know, I've learned a lot from insurance reps. I don't want to totally harp on them because I think I've learned so much from them. It was just this one in particular that it was it was kind of fun to educate her in, you know, in a respectful way. I wasn't mean at all, but I was like, can you please just check? Like, I really do know what I'm talking about. And it was it was fun to educate her in the same way that I've been educated from a lot of different insurance reps. And there it does not hurt to ask, you know, it never hurts to ask, get the patient's insurance information. I will say a lot of offices think they can bill medical for certain things when they can't. So really it goes twofold to where we're not billing enough medical and then we're like trying to overbill medical for things that don't have medical necessity. So it all comes down to that diagnosis code and really knowing what steps you need to take in order to check benefits for for medical coverage.
SPEAKER_00Oh, definitely. And and I think maybe you and I should dive into a series on that or something, because you know, this is one of those unique situations where like the the caller, the consumer knew more than the rep. Yeah. And that never happens, but that's it. That was I'm I'm so happy that you recognize that as like a a teachable moment to everybody listening to this episode, you know, like they're gonna learn something new. The reps don't always know everything, just like the EOBs are not always right.
SPEAKER_02Yes, right.
SPEAKER_00So it's just one of those moments where you gotta know when to push back, and you did. And so what end up what what is the final verdict of how this is all gonna play out?
SPEAKER_02Yeah, so I ended up calling the oral surgery office and asking that they bill medical for that, and they basically were like, no, we're not gonna do that. And I was like, okay, can I tell you how? Got to the point where I was like, this is the code you're gonna use. On this line, you're gonna put the referring, but like it was I had to lay it out line item by line item for them.
SPEAKER_00CMS 1500?
SPEAKER_02Yeah, oh yeah, yeah, literally tell them exactly where everything was. You know, I mean, I can bill it as a you know, self-submit, but they'll probably get paid faster and they have all the information faster. And so I was like, if you could just fill it, that'd be great. And so I ended up teaching them basically how to bill that process. It's a newer office too. So I don't know if like the the billers actually knew what they were doing, but it was a great teaching moment. Again, like I was able to teach them that, and hopefully more patients are gonna benefit from that. And, you know, it taught me a lot of things in how I need to present this. So, you know, like I said, I'm gonna work on that guide that I really want to have available for you guys that specifically walks through like the codes, the process, the verbiage, what you need to submit. And you can find that on my Instagram, hygiene
Teaching The Oral Surgeon CMS-1500
SPEAKER_02unlocked. But I just want to break it down to like very actionable steps because most people are just Googling it and trying to find the most applicable thing. And I just want it broken down like what I wish I would have had initially. So what ended up happening now is we are going to get 80% coverage. We have a pretty low deductible through my husband's work. So we have 80% coverage for the extractions, which is going to cover more than dental would have covered at half.
SPEAKER_00So oral surgeons making more money. Yep. Amazing. Absolutely amazing. How often do you get a patient that comes in and says, I'm gonna show you how to make more money?
SPEAKER_02I know. Initially, I think they were like really taken aback, like kind of like, who is this chick? But now I think they're like, oh, okay. And now they're they're listening a little bit more. But yeah, and it's less out of pocket for us. Like that's the that's the real benefit that I'm seeing now as a consumer, is it's less out of pocket costs. It's more coverage for things I am already paying for. I'm paying my insurance premiums, you know, every month. And now I can also save my dental insurance benefits for my dental coverages. Yeah. So now we don't even need to build dental because they won't cover anything because medical covered more.
SPEAKER_00That's amazing. That is absolutely amazing. So many like nuggets in this episode, like the biggest one being pushback. Don't always take the rep's word for it. Yeah. Because sometimes you actually do know what you're talking about, right? Like, yeah, I think a lot of billers would just say, Oh, well, the rep knows, so I guess she has to transform me to dental.
SPEAKER_02So well, and they probably would have asked for the you know, 7240, 7210 codes, you know, instead of asking for the CPT codes. So knowing you're cross-coding, which is why I'm trying to help educate people on this, is like you need to know the codes to specifically ask the rep so that you can get that. But honestly, like it's one of those things that once you see it, you can't unsee it. Once you know you can't unknow this, yes, and it will completely change how most billers look at billing.
SPEAKER_00It'll change, it'll you'll level up to that a biller, the
The Final Coverage Outcome
SPEAKER_00a biller that I talked about in my episode. I mean, I that is everything. So I mean, I perfect example of you know having an A player manage your revenue cycle, you knew when to push back, versus having a player manage your revenue cycle. So I mean, so good, Jen. I mean it's always good to have you on the on the podcast, and we're gonna hear from you a lot more.
SPEAKER_02Yes. Yes, happy to come back and talk more about all this.
SPEAKER_00Oh my gosh.
SPEAKER_02I'm very passionate about it, obvious.
SPEAKER_00So you have your Instagram is hygiene unlocked.
unknownYes.
SPEAKER_00You also have a TikTok, Hygiene Unlocked. So everybody go follow Jen there because she shares these types of nuggets all the time. So I'll go there and then you're gonna release this cheat sheet. Is that what it is?
SPEAKER_02Yeah, yeah. It's basically just going to be a cross-coding guide that offices can use to literally break this down step by step. So that should be coming out in the next few weeks. So make sure to follow so you guys get the alerts for that because it's gonna be nuggets.
SPEAKER_00Yeah, what kind of procedures are you thinking are gonna be on this? Like obviously wisdom teeth.
SPEAKER_02Yes, obviously wisdom teeth. Yes. Also, I'm even gonna break down like fillings for drug rehab, full full mouth reconstruction, fractured crowns due to accidents, period issues due to cancer treatments and diabetes, things like that.
SPEAKER_00So medically necessary, all medically necessary. Yeah, yeah.
SPEAKER_02Yep. So cross-coding and pairing, diagnosis code pairing, so that you know exactly what codes can go with what CPT codes. Right. So it's gonna hopefully it's just gonna be, you know, it's just gonna be nuggets of information that you can practically take and take it to your office and start using.
SPEAKER_00Yeah. And that's that's the beauty of these guides that you create because it all of that practice, you know, the practice runs and the mistakes and the errors and the rejections and
Cross-Coding Guide Coming Soon
SPEAKER_00the denials, all of that, you've tested all of that. So this these cheat sheets are gonna be so useful and ready to implement right away.
SPEAKER_02Yeah, and I don't like all that fluff. Like, I'm not gonna make you jump to the bottom to get to the bullet points. Like so my gosh, thanks for that thing. Yes. So I'm like, this is going to be actionable, step one, step two, step three, and exactly what you need to do. So I think it will be really helpful for billers at least training you to start thinking differently and start getting you to think medical necessity. Why are we doing the things that these patients need?
SPEAKER_00I talk about that. I think every biller needs to know the distinct definite, the actual definition of medical necessity versus dental necessity. Like you have to know how to use those terms and prove dental or medical necessity with sufficient evidence. So, but that's a whole other conversation. I'm not gonna get it. That's another rabbit hole. Yes, that's another episode. Jen, it was so good having you on the on the podcast again. I I mean, I'll probably talk to you 10 more times today, but yes, as far as this episode goes, we'll close it out. If there's one thing you want to leave the listeners with, what would that be?
SPEAKER_02Think differently. Think outside the box. I think we need to dive deeper as billers and not just go through the motions. I think that is one of the biggest pitfalls that billers get into and and clinicians too. Honestly, a lot of clinicians I talk to too, but just think differently, think outside the box, think about how we can get benefits for our patients that they're paying for and help them in a way that is more than just the status quo.
SPEAKER_00I love it. Okay, well, thank you for sharing all these. You're welcome.
SPEAKER_02Thank you for having me.
SPEAKER_00Yep, and I'll see you in the next one. Okay.
.JPG)
