The core of the problem?

Lately my office manager has been complaining that Cigna has been rejecting our claims for cores placed in crowns that have had root canals after the placement of a crown.This is disturbing, since most dentists know that teeth with perfectly fine crowns may eventually need a root canal treatment. This treatment is accomplished by drilling a hole in the occlusal surface of the crown to give access to endodontic files needed to perform the root canal. Afterward the crowns are usually still OK, but need to have a composite core placed to fill up the tooth's chamber and permanently seal the access hole. These cores are a type of composite filling but have their own insurance code (D2950) and are similar to regular fillings but differ slightly in how they may be done and may require additional effort as compared to a simple one surface composite. Usually some sealer needs to be placed over the gutta percha and then composite filling material has to placed deeply into the chamber and filled up to the access hole. It certainly is a different procedure than just placing a one surface post composite and deserves its own code. My fee for a two surface post composite is about the same as my fee for an endodontic core.

It seems a shame that the only way for some insurance companies to allow a core is to treatment plan a new crown, when it is not really needed. Most likely the insurance companies will approve a post and core more quickly than a core without a post.This is unfortunate since  most molar teeth do not actually require placement of a post because their chamber will provide sufficient retention for the core and no post is actually required to provide additional retention.

 Most of my  endodontists  request that a restoration be placed  as soon as possible after they complete their root canal , but if insurance companies are denying payment for this procedure then we have no really good options since patients may have difficulty approving  this work if there is a possibility that  their insurance company denies reimbursement. They may prefer  that we pre-certify this procedure and it is not unusual for treatment to be delayed while we send in an initial precertification , followed by re -submissions, with explanatory notes asking for reconsideration, after the first pre-certification is rejected.

Billing for a simple filling is an alternative, but it really is a different procedure since a permanent filling doesn't imply that a crown will follow soon and an insurance company could deny a crown on a tooth that has a recently placed filling. This is an example of "no good deed goes unpunished" in that a dentist treatment planning a core instead of a post and core is not only sacrificing some addition income because he or she believes it is best option, but he or she risks not being fully reimbursed for the actual core placement . In my opinion choosing to fabricate a post and core instead ,  just to get reimbursed, is not really a good option for most of my patients with molar root canals.





from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/08/the-core-of-problem.html - http://lspindelnycdds.blogspot.com/