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Lansdowne periodontics and Implant Dentistry

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Lansdowne periodontics and Implant Dentistry Reviews (1)

[redacted]., an 11 year old child, was seen on 8/23/2016 for a periodontal evaluation. His father was present, he was referred by his pediatric dentist who was concerned about increased gingival recession on the lower front teeth. A comprehensive examination was done. A diagnosis and treatment...

recommendations were explained and given to the patient, his father and a report was sent to the referring pediatric dentist.A claim was sent to [redacted] for a comprehensive exam ([redacted]). [redacted] declined payment for the claim since it is subject to frequency limitations. It is a covered procedure but the patient had already had the maximum number of exams allowed per year. The regular fee of the exam is $188 but even though it was not a covered procedure, the discounted [redacted] insurance fee was honored ($106) and billed to the patient’s parents. The patient parents called the insurance and report that thye was told by the insurance representative that the comprehensive exam code of [redacted] is only for: general dentist to use. They want us to submit the visit as a different procedure code ([redacted], professional consultation) because they were told that it will be covered since he is allowed 3 per year and has not used them.We are attaching a copy of the 2016 CDT (Code of Dental Procedures and Nomenclature), This was developed by the Federal government as the national terminology for reporting dental services on claims submitted to third-party payers (Insurance companies), I performed a comprehensive oral evaluation on [redacted]. (coded as [redacted]). As you can see from the definition for the code, it is used by a general dentist: and/or specialist so what they report that they were told by [redacted] is incorrect.I have been personally in communication by phone initially and then by email with [redacted]. I submitted him the information regarding the federal government definition of a comprehensive exam ([redacted]) that is not limited to general dentist but also specialists. His reply was that we should not have done a comprehensive exam, that his son was not a new patient since he was referred and that he came to us simply as a referral for an opinion.My response to him was that [redacted]. is/was a new patient in my practice and may need periodontal treatment in the near future and/or should be monitored. I also did not "simply" gave an opinion but did a careful examination of his son to provide my professional opinion and recommendation that in this case was not to recommend any surgical treatment now but to consider orthodontic treatment to help prevent increased gun recession in the future. To get to that recommendation, I can not only look at the 2 lower front teeth, I have to examine the whole mouth. Furthermore, [redacted]. is scheduled for a 6 month follow up evaluation. If a comprehensive exam was not done initially, we could not do a proper follow up examination without a comprehensive baseline evaluation. Our concern is that changing an insurance code so a claim will be paid instead of using the proper code for a procedure that was actually done could be considered insurance fraud or unethical.As a courtesy to [redacted]. we are sending a new claim with the different code ([redacted]) requested by the patient's father since he reports they were told so, by a [redacted] representative.I hope all parties involved do not miss what is of most importance, the fact that [redacted]. got the proper evaluation and treatment recommendations to help him maintain his oral health.Please find attached the 2016 CDT (Code of Dental Procedures and Nomenclature) regarding the [redacted] definition.Please let us know if you need any additional information. Best regards,Claudio I[redacted] DDS, MS

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Address: 19490 Sandridge Way Suite 270, Lansdowne, Virginia, United States, 20176

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