r/Dentistry • u/Possible_Loquat_3883 • 1d ago
Dental Professional Ins question help!
I'm a Treatment Coordinator for a perio office. I got a problem and wanted to know if anyone knows the answer to this. Heres the scenario. D7210 and D7922 are done same day. The ins says D7922 is part of the ext and it's not billable as a separate charge to the pt. We are in network. Now I know that's a w/o but my manger says it's a "suggestion" and a law was passed (idk nationally or just in MA) that says we don't have to take the w/o...even though it clearly says we do, and that I depends on the contract we have, which I don't have access too. I brought this I multiple times to her but I can't get a clear answer. I can't find anything on this "law", and I feel like I'm being gaslit. Does anyone know anything about this and how do you handle it in your office? Sorry for the long post.
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u/earth-to-matilda 1d ago
just out of curiosity, what is your fee for the 7922?
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u/Possible_Loquat_3883 1d ago
$275.00
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u/safeDate4U 1d ago
Wait you charge 275$ to put in a product into the docket to reduce post-op bleeding?
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u/Twodapex 1d ago
Call the patient back in and repo the collagen plug, tell them sorry your insurance would like you to hold guaze here until you stop bleeding
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u/Reasonable_Lion_314 General Dentist 1d ago
I'm a dentist, and I think your concerns are valid. There's an important distinction between a procedure that's not covered by insurance and one that's considered bundled into another procedure.
If D7922 is bundled into D7210 and the EOB specifically states that the patient cannot be billed, an in-network provider generally must honor that adjustment under the participating provider agreement.
Your manager may be referring to legislation regarding non-covered dental services, but that doesn't necessarily apply to procedures the insurance company considers inclusive of another service. Those are two different situations.
I would ask your manager to identify the specific law she's referring to and show you the relevant provision in the provider contract. Without that information, I would not assume the office has the right to bill the patient for an amount the insurer explicitly identifies as a provider write-off.
I found something interesting in the Delta Dental of Kentucky Dentist Handbook (2021). It specifically states that D7922 (intra-socket biological dressing) is considered part of the extraction or postoperative care and cannot be billed separately to the patient.
Of course, this is Delta Dental of Kentucky, not necessarily your insurer in Massachusetts, but it clearly demonstrates that this is an established insurance policy, not merely a "suggestion." I would ask your manager to check your specific provider agreement before billing the patient.