How to Bill a Dental Procedure (CDT) Code on a Medical Claim

Note: This feature supports the submission of medical insurance claims for customers using the Medical Billing module. For more information, see Sensei Cloud Medical Billing.

Sensei Cloud supports the submission of dental procedure (CDT) codes on medical claims. You can bill dental codes on a medical insurance claim if you enable alternate billing for the procedure codes and the medical insurance plan that the claim is being submitted to.

For example, an oral surgery office may want to bill a tooth extraction procedure code to a patient’s medical insurance plan. Including the specific dental procedure code (e.g., D7240 extraction code) on the medical claim better conveys the specifics or difficulty of the procedure to help ensure more accurate adjudication. 

Note: The alternate billing settings must be enabled for both the insurance plan and any procedure code to ensure that the CDT code is used on any medical claims.

To enable alternate billing for an insurance plan:

1. Navigate to the insurance plan (Patient Record > Insurance Information or Admin > Insurance > Plans).
2. Click the Plan Name. The Update Insurance Plan window is displayed.
3. Select Alt. Procedure Codes.
   
4. Click Update.
   Note: When an insurance plan is enabled for alternate billing, it is enabled for every patient that has the plan. You do not have to enable it for individual patients.

To enable alternate billing for a procedure code:

1. From the Administration tab, select Procedures & Fees > Procedure List and Fee Schedule.
2. Click the office code. The Update Procedure window is displayed.
3. Ensure that the appropriate dental code is selected in the CDT Code field.
4. Use the CPT Code field to search for the appropriate medical cross-code (e.g., 41899 for extractions). Note: You can search by code number or description, using a minimum of three characters for the search.
   The CPT Code and full Description are displayed.
   Note: You cannot enable alternate billing for a procedure code without first selecting both a CDT code and a CPT cross-code. See How to Use CPT® Codes for Medical Billing for more information on cross-coded procedures.
5. Select Enable Alternate Billing.
   
   Note: Selecting the Enable Alternate Billing setting allows you to include the dental procedure code on a medical claim. 
6. Click Update.
   Note: When a procedure code is enabled for alternate billing, then it is enabled in all cases when it is billed to a medical plan that is also enabled for alternate billing. 

If a patient’s medical insurance plan and the procedure code both have alternate billing enabled, your practice can bill the dental procedure code on a medical insurance claim.
The procedure code is still ultimately what is planned, scheduled, completed, and posted, but when the medical claim is generated, it includes the defined CDT code (for the same procedure) instead of the associated CPT code. If either the plan or procedure do not have the Enable Alternate Billing option selected, then the CPT code is submitted on the medical claim.

Note: The primary plan is billed first by default, so you may need to select a different plan from the Insurance to Bill drop-down list when submitting the claim. See How to Submit Medical Claims and How to Manage Secondary and Subsequent Insurance Claims for more information.