Anesthesia Coding Alert

Patient communication is always important,but it is especially necessary prior to elective procedures like dental care to ensure the patient understands his or her financial responsibility.

Dental insurance supplements the cost of dental care but often does not provide total coverage for dental surgery or anesthesia as health insurance does. (For example, the plan might reimburse the dentist $350 for a root canal when he or she charges an average fee of $1,000 or more.) Few insurers cover elective dental procedures, which means anesthesia services for the procedure aren't covered either.                                                                                                   

Because of this, most anesthesiologists will require  payment prior to or at the time of service, says Scott Groudine, MD, an Albany, N.Y., anesthesiologist. "Most anesthesiologists don't participate with dental insurers because they pay poorly," he says, "which means you should collect payment from the patient. If the patient is told up front that he is responsible for payment, he can check with the carrier to determine whether he'll be reimbursed, and for how much. They need to know if reimbursement will be poor or lacking so they can cancel the surgery or appeal the carrier's decision before proceeding with elective surgery."                            

 Some Medicare plans include dental coverage. In those cases, Groudine says the anesthesiologist must take payment if he or she participates in Medicare. The anesthesia provider may also have the patient sign an advance beneficiary notice (ABN) if he expects the carrier to deny payment.