Effectively quoting downgrades on Molar vs Premolar

[mdunham]

How many of you would like to know how to effectively differentiate a downgrade of materials between molar and premolar adjustments per plan without having to change your blue books constantly OR, giving incorrect qoutes on tx plans and ledgers?       For instance a  downgrade from composite to amalgam on Molars,  or all porcelain full coverage on Molars vs payments on premolars?   

[mdunham]

I know how to do this, and I am willing to share.    

[FormerPLM]

Cool!  Please share!

Thanks,

Jeff

[vg2180]

I would like to know please.

[mdunham]

 To correctly estimate downgrades.   

First:   Enter ADA code list and create  the following codes:

 2391.1 Premolar 1 Surface Posterior Composite

2392.1 Premolar 2 surface Posterior Composite

2393.1 Premolar 3 surface Posterior Composite

2394.1 Premolar 4 surface Posterior Composite

2740.1 Anterior All Porcelain Crown

2740.2 Premolar All Porcelain Crown

2740.3 Molar All Porcelain Crown

(do this for Porcelain fused to metal crowns if you see a trend in downgrades with these as well.)

  Enter the same also for the 6740 and corresponding Pontic Codes as well.     I enter Anterior, premolar and Molars as companies pay differently on these within the same plan.

Second:

Mark Inactive the Original code. Use your "locator code"  instead.  (Locator Code is my term for coding by tooth location.) 

Third:

Now Enter all of these codes into your allowance tables using the same FEE as your general codes.   

Fourth:   When you enter your blue-books entries, be sure to create these codes.   Now your treatment plans should be correct!     See my entry below, which is only showing fillings of course.

[mdunham]

See Below

[mdunham]

see below

[dhauptmann]

This looks great, but I do have a ?  using the premolar composite code 2391.1 will this code print on the claim form as 2391.1 and will the insurance companies recognize this code, since it is not an ADA code?  I really like the concept of doing this for the blue book but only if there will be no problem with the insurance claims.

[mdunham]

Denise,    Any "point" codes DO NOT print with the Suffix code attached to it.    It will merely print as the regular ADA code.  

Reports gather all information for ADA codes by using the numbers prior to the suffix code, or "point code addition ".  

In summary,  your reports and your claim forms will be fine.     

We we have done this for about several years now with great success. 

[d_canales]

Great method and great job of explaining!  Thank you, Melissa!