News On LANAP

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I was approached by a competitor of Millennium regarding their laser, and it prompted me to seek an answer to a question many have asked: if you code these things as osseous surgery ( 4260) how will that not leave you open to an accusation of insurance fraud?

I have an acquaintance who works for the FBI in white collar crime, including insurance fraud. He knows the investigators at the various insurance companies, and he asked them for me.

What he was told is that Blue Cross has communicated with the ADA, and was told that 4260 is fine for LNAP, the usual and customary fees are also okay. They have also said that the insurance companies may require additional training or proof of such as a requirement of payment.

It took a while for that last bit to soak in.

So the vendors for lasers ( I assume that this understanding is not exclusive to Millennium) can determine that my specialty training, my being boarded, my experience is irrelevant, and the insurance companies will enforce it. Has the ADA has sold us down the river? Where is the AAP in all of this?

Am I misreading this?

Jim

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Jim,

That is amazing.
I can understand (don’t agree) the rational for insurance companies to classify LNAP as osseous surgery. The description of want constitutes osseous surgery is vague. Ironically, last week I had a discussion with a UC dental advisor(GP) because in his opinion osseous surgery wasn’t appropriate to treat 6mm pockets. He suggested a submit for a gingival flap procedure, as in his opinion osseous recontour wasn’t necessary.
In regard to LNAP, if unique training or equipment is required for a procedure, there should be a specific ADA code describing the procedure and it’s requirements.

Chuck

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I checked with Jerry Zackin about 4240 and Perioscopy because we are “reflecting” the tissue to see with the camera. NO GO…

At least the LANAPers can get some surgical fees out of the “surgical protocol”. BUT since maximums are so low compared to fees it does not do much good unless you have a union plan that has no max.

Even with FM scope cases we get to the max quickly, although out of pocket tends to be much lower than surgery.

Patients love any idea that involves lasers though. Are the “blinded by the light” ? (who remembers Manfred Mann?)

Remember those that went before you this weekend. The price of freedom is paid dearly by our real “American Idols”!

All the best,

John

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Hi John,
Patients do love lasers, what about a tiny laser attached to the next generation scope or retrofitted to the first generation? ( just for saying this is a laser too, non functional)

Mark

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The PeriFauxLaserScope. That’s it! Sheezzz, what will they think of next?

All the best,

John

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I like it

Mark

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OK, John –

I know as a New Yorker I am ethnocentric, BUT:
1. Blinded by the light was recorded originally by Bruce Springsteen.
2. According to the LANAP people, they say they qualify for osseous surgery as they reflect the entire flap (though there are no incisions made).
I truly believe they are trying to do anything to get these procedures covered. We use the more “appropriate” destruction of oral lesion (I can get the number if you need it). It is almost never covered, but at least we believe it to be a more appropriate description of what we actually do with the laser.

Bob

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Couldn’t resist – though I am in Israel, it makes it feel more like “home”.

Bob

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The Boss. Writer for Manfred Mann? Yep! You called it, Boss !!

John

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Springsteen at the LA Sports Arena. Halloween, late 70’s. Legendary. Are you teaching, beaching or mazel toving in Israel?

Mark

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