Why doesn’t dental insurance coding cover the diagnostic work complex cases require?
Because insurance coding was borrowed from medicine and designed around routine general dental care. The codes recognize ‘complete exam’ and ‘limited exam’ but neither matches what a comprehensive diagnostic visit for a $40,000 case actually requires. Insurance reimburses the simple version. The detailed photo set, mounted casts, occlusal analysis, simulation work, and CT scans are all uncovered. Practices that try to fit comprehensive diagnostic work into the insurance reimbursement schedule end up cutting the diagnostic step short, producing worse treatment plans, and making themselves harder to differentiate from any other dentist who does the same minimal exam. The fix is to step out of the insurance schedule entirely for complex cases and charge directly for the diagnostic work that the case needs.
If the answers you are finding here resonate with you, my team and I work with a small group of clients each year. The next step is a complimentary Discovery Consultation and Practice Review with Dr. McAnally.