I need to know the correct way of handling failed and/or ongoing procedures and how to bill for them. This has been a debate in our office. If a patient’s restoration has failed, whatever the reason, and they have insurance, do you report that to the insurance company? For example, a patient gets an amalgam filling and six months later it needs to be redone. What is the most appropriate course of action, doing an adjustment in house, or filing it to the insurance company and adjusting it off afterwards? Some do not want to file and some do. If it was a self pay patient we would adjust it off and not make them responsible. Our insurance patient’s are not responsible either, but is it necessary to report it to the insurance company? Please let us know the most appropriate course of action. Thank you.

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  • I need to know the correct way of handling failed and/or ongoing procedures and how to bill for them. This has been a debate in our office. If a patient's restoration has failed, whatever the reason, and they have insurance, do you report that to the insurance company? For example, a patient gets an amalgam filling and six months later it needs to be redone. What is the most appropriate course of action, doing an adjustment in house, or filing it to the insurance company and adjusting it off afterwards? Some do not want to file and some do. If it was a self pay patient we would adjust it off and not make them responsible. Our insurance patient's are not responsible either, but is it necessary to report it to the insurance company? Please let us know the most appropriate course of action. Thank you.

I need to know the correct way of handling failed and/or ongoing procedures and how to bill for them. This has been a debate in our office. If a patient’s restoration has failed, whatever the reason, and they have insurance, do you report that to the insurance company? For example, a patient gets an amalgam filling and six months later it needs to be redone. What is the most appropriate course of action, doing an adjustment in house, or filing it to the insurance company and adjusting it off afterwards? Some do not want to file and some do. If it was a self pay patient we would adjust it off and not make them responsible. Our insurance patient’s are not responsible either, but is it necessary to report it to the insurance company? Please let us know the most appropriate course of action. Thank you.

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Asked on December 1, 2016
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You always bill any treatment performed to the carrier. If you utilize ICD-10-CM codes on your dental form the amalgam re-do should be covered please look at diagnosis codes K08.5 unsatisfactory restoration of tooth

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Answered on December 2, 2016
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