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CAD/CAM international C.E. magazine of digital dentistry North America Edition, No. 3, 2016

32 I I practice management_ onlays usuallypaidbycarriersattheleastexpensivealterna- tive treatment fee, frequently comparable to the fee for an amalgam. Depending on the cusp involvement, onlays may be a paid benefit with no alternative clause, typically at 50 percent of the insurance carrier’s fee schedule ormaximumallowablebenefit.Manycarriersrequire that two or more cusps of a tooth be involved in the onlay and may specify how much of the cusp incline mustbeinvolved(usually80percentormore)inorder toqualifyforabenefit.Whenthedecayorfracturein- volvementofatoothwouldbesufficienttogenerate abenefitforacrown,thenanonlaymayalsoqualify. To maximize your reimbursement potential, start by using the appropriate insurance codes. _Prove the pathology with pictures Inordertoincreasethepotentialforfullinsurance reimbursement for onlays, the pathology of a case must be appropriately documented. A standard X- ray and clinical notes are no longer enough; detailed pictorialandwrittenexplanationsarerequired.Begin by taking a pre-op periapical X-ray. Even if you think you won’t need one, it’s a good practice to get in the habit of ordering one. Next, follow with clear pre-operative photos that show the entire quadrant of the tooth. Insurance will typically approve reimbursement if adequate documentation demonstrates that the restoration incorporates three-quarters of the tooth. Photographs taken during the procedure should highlight anything that is of clinical concern, like leakage, fractures or decay. Removing caries while preparing a tooth may be expedient, but the practice may also keep you from being fully reimbursed. Be sure to take photos during the preparation process to prove the pathology before moving on to the final restorative steps. Keeping a digital camera and notebook handy will aid in documenting each case and should become part of your standard operating procedure. _Be persistent — you’re the expert If after accurately documenting a case with pho- tos and case notes, you are denied or down-coded to a different procedure, make a point to challenge thedecision.Beaggressiveinyourpursuit,especially whenyouareabletoclearlyshowtheprocedurewas inthebestinterestandwell-beingofthepatient.Re- state your case and your professional assessment in a formal letter. Do not allow a third party or clinician advisor who was not part of the case to dictate what you believe is in the best interest and well-being of your patient. _Conclusion Expanding clinical indications on chairside mill- ing systems beyond crowns provides dentists with a market opportunity that can significantly increase practicerevenueandROI.Manyofthedirectrestora- tion cases currently being performed would benefit from onlays. Understanding how to appropriately documentanonlaycasetoincreasethepotentialfor insurance reimbursement, as well as the availability of VITA ENAMIC, an ideal material for onlays, pro- vides dentists with the optimal tools to successfully include an expanded indications strategy in their practice and provide better patient care with long- lasting, high quality results._ CAD/CAM 3_2016 Fig. 3_With no furnace required, VITA ENAMIC has been shown to decrease chairtime by up to 50 percent for greater practice profitability. Fig. 4_Onlays vs. direct restorations represent a significant opportunity for doctors with chairside milling and require practices to be savvy in material selection, patient conversion and insurance documentation. Fig. 3 Fig. 4

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