Guidelines for billing medical insurance for the NTI-tss
The original outline of these billing guidelines were provided by Rose Nierman of Nierman Practice Management, 1-800-879-6468 from the Dental Letters Express ™ Software for insurance narrative reports (Thanks, Rose.  You are a class act!)
NOW AVAILABLE!  NTI Medical Insurance Billing Wizard.  
(The software does it all for you, or do-it-yourself with the documents below).  
(click here for guidelines for dental insurance billing)
1.  Insurance Intake Form   To be completed by the patient prior to medical insurance billing.  Provides sequential information used in the SOAP narrative (#2 below), but is not submitted to the insurance carrier (only #2 and #3 below are) 
Clinical Examination form  Some data from this form will be inserted into the SOAP report.  When downloading, the password asked for is the last name of the father of modern dentistry:  G.V. _ _ _ _ _ .
2.  Narrative in S.O.A.P. format  For reimbursement or preauthorization.  Customize this narrative from the information gathered from the intake form in #1 and submit to carrier with Claim form (#3)
3.  Medical Insurance Claim form  Complete as any insurance form, using the codes cited in the SOAP.
 Patient's Headache History  The patient complete's this form prior to their clinical visit and is evaluated by the pratitioner as an aid in diagnosis. (A second page is provided for the practitioner's use which helps to explain the rationale for each question) 

Considerations in Migraine Therapy and Medical Insurance Submission
NTI-TSS, Inc. thanks Dr. Michael Melkers for providing these insurance billing insights and forms.

The NTI appliance has been a wonderful addition to our practice.  Since the year 2000, we have enjoyed incorporating NTI therapy into our practice.  It has virtually replaced the full orthotic therapy that we had previously been prescribing. 

One of the most exciting indications for the NTI-TSS device is the prophylactic treatment of migraine pain.  As the NTI-TSS device is actually approved by the FDA for this type of treatment, we have had great success in further helping our patients by having this treatment covered by their medical insurance. 

The following protocol is intended as an aide to facilitate your office in receiving medical reimbursement for NTI-TSS treatment, when prescribed for the prophylactic treatment of migraine headaches. 

The essential steps for obtaining medical reimbursement are: 

  • 1. Appropriate patient history
  • 2. Confirmation of medical insurance coverage and limitations
  • 3. Confirmation of medical diagnosis and medication history
  • 4. Collection of subjective and objective examination data
  • 5. Assessment and Diagnosis 
  • 6. Submission of medical claim and narrative
  • 7. Appeal letter follow up (if necessary)
To simplify the process, we can further organize these steps into three areas; pre-clinical, clinical and post-clinical.  In each step, be aware that the information collected will be used to diagnose and treatment plan for our patients.  Organized into the standard SOAP (subjective, objective, assessment and plan) format, narratives can easily be generated for insurance claims submission. 

Pre-clinical
The forms associated with the pre-clinical phase of data collection is the Insurance Intake Form and Patient's Headache History

Clinical
The form used during the clinical phase of data collection is the Clinical Examination form.  Thise form will facilitate the collection and organization of additional subjective as well as objective data.  An assortment of the most commonly used ICD diagnostic codes are also included in the assessment area of the form.  (The list of codes is intended to be an organizational aide and not a limitation of the possible diagnosis). 
At this point, the clinician should hopefully have sufficient information to recommend treatment (the Plan component of the SOAP format.)  In our experience, the NTI is generally coded using one of the following. 
 

  •  CPT 21110-52  Interdental Fixation Device.  This code is our most commonly used in our practice for NTI therapy.
  •  CPT D7880  Occlusal Orthotic Therapy.   This code has been recommended for submission to BCBS


Perhaps at some, point the groundbreaking nature of the NTI may warrant a new code for submission. For now, we must work with the codes that are available to us.  The “fire” behind these codes is the FDA approval of the NTI device for the prophylactic treatment of migraine pain, which must be emphasized in any communication or submission for medical insurance reimbursement. 

Post-clinical
At this point, we will be either submitting for reimbursement or preauthorization of treatment from the patient’s medical insurance company.  This may depend upon the limitation or requirements of coverage, the patient’s desires or individual office policies.  It has been our experience that while a number of policies require pre-authorization, approval can be obtained immediately by phone and fax or within 7 to 10 days.  The remainder of claims may be submitted following treatment.  Reimbursement may be directed to the patient or provider's office, again depending upon individual office policies. 

Having followed the pre-clinical and clinical protocols described above, the actual submission of the medical claim is easily executed.  The submission should contain two essential items; a detailed narrative letter and a Medical Insurance Claim form.  The claim may be submitted either on a traditional ADA form or a medical claim form provided by the patient.  (Some dental management software may be able to generate either of these forms.)  Usually, a quick call the to patient's employer is all it takes to get a form sent of fax'ed to you. 

The properly written Narrative in S.O.A.P. format can facilitate rapid approval of the claim.  A poorly written, vague narrative can doom the claim to denial and a potentially time consuming appeal process. 

Conclusion
Medical claims submission for migraine therapy with the NTI-tss device is neither complicated nor mysterious.  By following these simple steps, you can provide your patients with a higher level of service and help the get the most out of their insurance benefits.  Be honest and be diligent.  We have the opportunity to pave new ground in the treatment and claim submission for our patients. 
 

 

2303 Blue Smoke Trail
P.O. Box 340
Mishawaka, IN  46546-0340