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When Procedures Involve Multiple Appointments

For crowns, bridges, dentures, partials, etc, there is usually a prep or impression appointment and then a seat or deliver appointment. You probably already have policies in place that specify whether the fee is charged at the first appointment or the last appointment. You need to decide which method to use before setting up your procedure codes. Here is how you handle each situation:

Fee due at first appointment: 
Advantage: A more effective way to ensure the practice collects the money for the procedure. The responsibility falls on the patient to follow up and make sure the crown gets seated, etc. The patient is charged whether or not they return. This makes sense because most of the time and money invested by the dentist is at the first appointment and in the lab work.

Some insurance companies prefer the procedure to be billed on the prep date, although many do request to be billed on the seat date. In spite of any insurance company's preference, you are probably within your rights to bill on the prep date. The treatment is substantially finished, and whatever crown or appliance comes back from the lab will not fit any other patient. Beware, however, that the insurance company may have a clause that the coverage date of the patient may only apply to the seat date. This may affect annual renewal dates and termination dates, so always keep the insurance company's peculiarities in mind when scheduling and billing. Make sure to include a sentence in the financial agreement that new patients sign explaining that the fee for major cases involving lab work is due when the work is initiated. When they sign and agree to those terms, it will make following up on their bill easier.

  1. Schedule the first appointment as the crown, denture, or whatever. For the procedure use the standard ADA code with the proper fee attached. Your default Procedure Note would be notes for the prep or impression. 
    Example:  3 carps 2% Lido-1:100k epi, prep, cord with hemostat, PVS, etc. -or- Alginate impression, opposing alginate, shade 102, etc.
  2. For the second appointment, use a special no-fee Procedure Code that is marked "do not bill insurance" and has a fee of $0. The code should not look like an ADA code (e.g. use a beginning N instead of the usual D to indicate no-fee). The procedure might be "Crown Seat" or "Denture Deliver". The procedure note would be your standard note for seating or delivering.
    Example: Removed temp, checked contacts and bite, showed to patient, cemented Fuji. -or- Delivered. Checked fit, bite, appearance, etc.

Fee due at the second or last appointment
Advantage: This method tends to more closely follow most insurance company policies. There will be less arguments with the insurance companies, less surprises, and less incidents of accidentally scheduling the patient in a way that results in insurance not covering the procedure. If the patient does not return for their second appointment, you should have policies in place to follow up and charge the patient for the lab fee they incurred. It may be hard to explain to the patient, however, that they did not originally owe anything, but since they did not come back, they now owe a fee.

Follow the steps above, except schedule the first appointment with the special no-fee procedure code that isn't billed to insurance, and the second appointment with the standard ADA code that is billed.  The no-fee code would be something like "Crown Prep" or "Denture Imp", with the appropriate procedure notes.


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