Healthcare Fraud Shield’s Latest Article: All You Wanted To Know About Fluoride Varnish, But Were Afraid To Ask!

10 Sep
Healthy gums and teeth are important, to overall health. Oral health is a predictor of overall health and wellness. The Surgeon General reports: “Dental decay is the most common chronic disease of childhood and affects a disproportionate number of low-income and minority children.” [1] According to the Centers for Disease Control and Prevention (CDC), Healthy People 2010 Final Review: [2] “Approximately 42% of children ages 2 to 11 years have dental caries in their primary teeth.”

What is Fluoride Varnish?
Fluoride varnish is a topical dental treatment, simple to apply that can help prevent tooth decay. It can slow it down or stop it from getting worse. Fluoride varnish is made with fluoride, a mineral that is proven to strengthen tooth enamel (strong outer coating on teeth).  

Once a child starts to get teeth it is recommended that preventative care including fluoride varnish are used to assist with oral health preservation. Baby teeth begin to come in about six months of age and permanent teeth at six years of age, continuing until early adulthood.

When should Fluoride Varnish be used?
The Bright Futures/American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Health Care Periodicity Schedule, [3] recommends the following schedule: “Age 6 months to Age 5 years.”

The American Dental Association (ADA)[4] recommends: “Varnishes must be reapplied at regular intervals with at least 2 applications per year needed for sustained benefit.”

Who can apply Fluoride Varnish?
Fluoride Varnish can be applied by trained health care providers like dentists, and primary care providers. It only takes a few minutes to apply and can be done during routine preventive health visits.

How is it billed?
Dental providers should be using dental code CDT code D1206 (Topical application of fluoride varnish).
Primary Care providers should be using CPT code 99188 (Application of topical fluoride varnish by a physician or other qualified health professional).

Most payors will have guidelines around the frequency of billing that may vary from 2-4 times per year. Make sure to be familiar with your carrier’s policies.

What to look for?
Dental claims and medical claims usually don’t run in the same claim platform.  Look for cross over billing.  i.e. dentists billing medical platform.  Additionally, watch for Dental providers who are billing D1206 (Topical application of fluoride varnish) and reporting D1208 (Topical application of fluoride).  Both codes can be used but should not be reported more than four times per year in total no matter the combination.

Primary care providers should not be reporting D1206 (Topical application of fluoride varnish) D1208 (Topical application of fluoride) as these are dental codes.

Finally, there should be an indication of high risk of caries (cavities) reported with any fluoride service code by either dentists or primary care providers. Most payors will have guidelines around the frequency of billing that may vary from 2-4 times per year.  Make sure to be familiar with your carrier’s policies.

If you have any questions or comments, please contact SIU@hcfraudshield.com.
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