Local Anesthesia in Conjunction with Dental Operative or Surgical Procedures

by  Christine Taxin, President - Links2Success
May 6th, 2022 - Reviewed/Updated Mar 14th

Who is looking at your office billing for all types of sedations? Who sets the standards?

• The Joint Commission is not specific as to the required elements of the assessment, the expectation is that the assessment is based on established or recommended professional practices. (Examples of professional organizations that provide guidance for clinical practice are the American Society of Anesthesiologists, American Association of Nurse Anesthetist, American Dental Association.) Typically, the assessment includes, vital signs, status of the airway and response to any pre-procedure medications.
• Moderate Sedation: The organization determines who is qualified to perform the assessment consistent with competencies of staff, scope of practice, rules and regulation and State. 
• Deep Sedation/Regional Blocks/General Anesthesia: must be performed by an anesthesia provider or LIP with medical staff privileges to administer deep sedation, regional or general anesthesia in accordance with hospital policy and state scope of practice laws. This assessment may not be delegated to a non-privileged individual.
• All codes belong to the ADA and the AMA which I am granted permission to use.

Dental Billing of Local Anesthesia is different from Medical Billing

Dental: D9215 local anesthesia in conjunction with operative or surgical procedures and D9210 local anesthesia not in conjunction with operative or surgical procedures are available CDT codes to report these local anesthesia services. Benefit plan limitations may exclude separate reimbursement benefits for local anesthesia. (Most consider it part of the treatment)

D9230-Analgesia, Anxiolysis, Inhalation of Nitrous Oxide — (The word anxiolysis is defined as "reduction of anxiety utilizing a pharmacologic agent such as Benzodiazipine or nitrous oxide.") This code refers to anxiety-controlling drugs. It may be a covered dental benefit when reported with oral surgery procedures. It usually is not a benefit for the use of nitrous oxide-oxygen sedation associated with routine dental procedures. (If you are billing this to a dental claim and it is a non-covered procedure look at your state laws since over 28 now can charge their fee for this service.)

Always provide a pre-visit screening of sedations patients:

D9912 pre-visit patient screening

Capture and documentation of a patient’s health status prior to or on the scheduled date of service to evaluate risk of infectious disease transmission if the patient is to be treated within the dental practice. This must be used at the time of billing, so you need it. Go over their health history and if needed contact their medical doctor to go over any issues you may encounter.

Medical Billing

• Pre visit patient screening for medical
• Medical Z01.818 - Encounter for preprocedural examination NOS 

Both Dental and Medical Require the following information to be documented:

What you will need to know prior to the visit.

1. Age of patient since there are different codes for patient under 5 and over 5 to adult.
2. Who is performing the sedation? The same doctor who is providing treatment or a different provider?
3. Health of patient

Below are the qualifiers to match these questions when billing medical, with dental they must be in your chart notes.

Health of the Patient–ASA Physical Status (American Society of Anesthesiologists)

ASA I: Normal, healthy patient
ASA II: Mild systemic disease (well controlled and no functional limitations)
ASA III: Severe systemic disease (controlled with no immediate danger but has some functional limitation)
ASA IV: Severe systemic disease that is a constant threat to life (poorly controlled or at end stage)
ASA V: Patient not expected to survive longer than 24 hours without surgical intervention
ASA VI: Brain dead (maintenance for organ harvesting)
ASA E: Emergency operation of any variety

These codes will be also needed when billing and knowledge of the patients age and health are needed. They match the standard set up from the American Society of Anesthesiologists. Most insurance companies use this list for office or clinical settings. 

Physical Status modifiers are represented by the initial letter ‘P’ followed by a single digit from 1 to 6 as defined in the following list:

• P1: A normal healthy patient
• P2: A patient with mild systemic disease
• P3: A patient with severe systemic disease
• P4: A patient with severe systemic disease that is a constant threat to life
• P5: A moribund patient who is not expected to survive without the operation