James Anderson

TMJ Exercises – Are They Covered?

In dentistry we are so accustomed to providing a tangible product or service. If you think about it, even cleanings we provide something for the patient to take home with them. Medical practitioners are quite the opposite. Generally patients leave with just the knowledge that was shared with them during the appointment. Maybe some literature. This may be the greatest struggle that we encounter with conveying to a dentist that their TIME is valuable.
For many patients TMJ pain is akin to migraine or chronic pain. They live with it daily, stress aggravates it and treatment for it is largely undervalued and not sought out. Many dentists believe in these exercises though and have seen their impact on patients in pain.
The first step with billing for TMJ exercises is to do a comprehensive TMJ work-up. This will include a questionnaire that both asks the patient’s symptoms and incorporates an exam of the patient with the doctor’s observations. Notating all pertinent symptoms and whether they are right, left or bilateral is vital to providing the correct diagnosis codes. Also notating if the patient experiences other related symptoms such as headaches or difficulty sleeping.
The majority of medical carriers consider diagnostic xrays and CT scans medically necessary to treating TMJ disorders. Pharmacological interventions can also be covered for TMJ therapy such as the use of steroids, muscle relaxers or injections. All of these can contribute to non-surgical or non-prosthetic TMJ treatment.
Lastly, it is important to document the amount of face-to-face time you spend with the patient at each follow-up appointment. You may find yourself seeing the patient one day for 15 minutes and then the following week they are having a tough day and you spend 45 minutes consulting and showing them new exercises or administering an injection. Documenting your time is what will govern the level of office visit the patient is billed for. TMJ treatment is an amazing service to offer to your patients and, when documented correctly, even mild treatments can be billed to medical insurance.


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