D7465 — It’s a Laser, Now What?

The laser has continually evolved into becoming one of the most powerful operative tools available to dentistry. Its many variations and flexibilities allow for today’s clinician to not only simplify, but also streamline most facets of specialty and general dentistry.

It’s a “hot topic” of late as more dentists are considering the purchasing of lasers but yet are wondering, “Where do I go from here?” This is a broad question that when broken down really asks, “What is the best way to bill and see a return on my investment, AKA the laser?”

However, the laser is not alone in this overall concept. The same can be said for cone beam and CT scan technologies, as well as digital impression techniques, and the many forms of in-office and laboratory-based CAD/CAM systems.

In this issue of Dental Insurance Today, and in the following three issues, I will open your eyes to a more simplified world of insurance reimbursement management. It’s not that hard to understand. However, there are steps to the process. Whether I’m teaching a class or consulting with a practice, I have found that there are basically similar questions that always get asked. It doesn’t matter if it’s in the morning or afternoon session; it doesn’t even matter if I’m on the east coast or west coast, the questions are generally the same.

I will be diving into these four questions, thoroughly exploring each one in subsequent issues. Take a few seconds and ask yourself which of these relate to your office and immediate situation. Is it 1 or 2, or maybe 2 and 3, or perhaps all four? And definitely number 4!

1. If I buy this laser (or invest in the technology), how do I bill for using it so I can get an immediate return on investment?
2. What code numbers do I use so the insurance company will pay and not ask questions?
3. Can I bill the patients’ medical insurance plan?
4. How do I make (more) money in dentistry? – These write-offs are killing me.

Let’s explore question No. 1.

How do I bill for using this laser so I get an immediate return on investment?

Dental lasers have two primary functions; they cut and they destroy. So what are we cutting? And, what are we destroying? If we are destroying a lesion, we have a specific code that identifies the completed procedure. That code is D7465.

D7465 – destruction of lesion(s) by physical or chemical method, by report.
Examples include using cryo, laser or electro surgery. (CDT-2016)

Code D7465 is the one and only procedure code that is specifically technique-sensitive to the laser. Rather than being surgically removed, the pathologic lesion is simply obliterated. For all other procedures where the laser is used, report the code that most accurately describes the intended as well as completed procedure.

For a frenectomy, the code is most often D7960 but when it’s a frenuloplasty, it’s D7963. For a periodontal gingivectomy, the code is either D4210 (four or more teeth) or D4211 (one to three teeth) and it’s D4212 when, after healing and resolution, a separate restorative procedure is completed. Yes, that is correct. Most all plans exclude benefits for D4212 when done on the same day as the restoration.

In a true fee-for-service environment, we simply identify and subsequently bill the patient for each completed procedure, as it is finished. The operative word here is COMPLETED. What code identifiable procedure did we do? And remember, it’s not finished or completed until there is absolutely nothing remaining that needs to be done. Production, billing, and subsequent collections are based on the finished procedure, not the technique utilized to complete it.

We must remember that a laser is nothing more than an adjunctive instrument that is utilized to complete a more definitive procedure. You would not routinely explain on a claim that you used a #11 or #15 Bard-Parker blade. Your treatment notes, however, are another story.

Benefit plans reimburse based upon the completed procedure. They accept no additional liability for the use of a laser, and most all plans disallow the office from separately charging the patient beyond the scope of the completed claim. The same holds true for the use of either a curved or straight blade. With the partial exception of D7465, CDT codes identify completed procedures, not specific techniques.

This same concept of CAC or “code at conclusion” is applicable to all technology integrations as concerns patient care. Bill and code for the completed procedure. Bill and code for exactly what it was you did as a completed entity. And here is the easy part – when the claim to the payer comes last in the sequence of events, you’ll never have the question as to what was completed and needs to be coded. Once you know what is completed and done, the process of code selection becomes automatic.

Question No. 2…

In our next issue, question No. 2, “What code numbers do I use so the insurance company will pay and not ask questions?” will be explored in depth. I will be sharing with you more of my simplified metric, whereby the clinical documentation on the date of treatment directs you every time to the one and only appropriate procedure code, thereby eliminating the forever concept of fraudulent concept of a “coding strategy.”

I’m eager to know your thoughts, so let me hear from you.

Until the next issue,
Tom M. Limoli, Jr.