I am asked daily from practices across the country “Why should we bother learning how to bill medical insurance when the medical providers are not interested.” My reply is, “They will be!”
The simple fact is, neither medical nor dental schools have included any significant study into the oral systemic connection. Even after years of experience and continuing education, the very idea is questioned, along with how these professionals would even collaborate.
This segues into another thing I’m often asked is, “What treatments can dentists and physicians collaborate on, and how?”
One example is a tooth abscess that can be caused by a bacterial infection of the teeth and gums. Sinus infection is another caused by bacterial infection but affects the sinuses of the face. Viruses, fungus, or allergies can be the reason for sinusitis, leaving patients with pain in their upper teeth, eyes, often with a headache associated.
Since the symptoms of these two infections include a toothache, people confuse the pain from an abscessed tooth with sinus infection that can be caused by a tooth abscess. As the symptoms are quite similar, you need to be extra careful when diagnosing. Luckily, there are some symptoms that can be different for a tooth abscess and sinus infection.
Symptoms that indicate the presence of tooth abscess are:
- Sudden and intense pain.
- Pain mostly in one or two teeth.
- Swelling of the gum or mouth.
- Redness can be coupled with swelling.
- A discolored or loose tooth.
- Extreme sensitivity to biting or cold.
- Fever and a foul taste inside the mouth.
Symptoms that indicate the existence of sinus infection:
- A pain that is continuous but not noticeable.
- Having fever or cough consistently.
- Congested nose or a runny nose.
- Pain felt in more than one tooth.
- Intensified pain when sitting or jumping.
- Unbearable earache or headache.
- No sensitivity to cold or biting.
Collaboration is key when diagnosis for the treatment is necessary. Both the Medical and Dental Provider are part of the process of elimination and the ability to diagnosis which treatment may be necessary. Sometimes the questions doctors ask may seem annoying, but they are to help them understand which treatment is necessary. But if the pain remains for more than 24 hour or even two to three days, it can be a dental sinus. So, look out for the common symptoms. They are –
- Swelling of your face.
- Pain while swallowing.
- Impaired sense of smell.
- Pain while eating cold or hot foods.
- Fever or consistent cough.
- Intense pain in upper molars.
Physicians can use the following to help diagnosis the area:
Used to diagnose acute sinusitis and rule out other conditions:
- Nasal endoscopy. (Medical Provider)
- Imaging studies. A CT scan shows details of your sinuses and nasal area. (Dental Provider)
Many providers ask: if they find the sinusitis – can they diagnosis the condition? YES, if you are taking a CBCT and show this you can use this diagnostic code:
J32.9 - Chronic sinusitis, unspecified Sinusitis (chronic) NOS Includes sinus abscess, sinus empyema, sinus infection, sinus suppuration.
Sinuses are hollow cavities in the bones of the face surrounding the nose and connecting to it through narrow passageways. Sinusitis (also called rhinosinusitis because it involves the nose and sinuses) is an inflammation of the tissues that line the sinus cavities. Allergens, viruses, bacteria, or other environmental factors can irritate these tissues, causing inflammation and an overproduction of mucus to try and rid the tissues of the irritants. Resulting inflammation and swelling can obstruct the narrow passageways, trapping mucus in the sinuses which then can become infected. There are four sets of sinus cavities:
- Maxillary: Located on either side of the nose
- Frontal: Located just above the eyebrows
- Ethmoidal: Between the eyes
- Sphenoidal: In the bones behind the nose
Sinusitis is coded based on type, location, and duration, as follows:
- Acute sinusitis: Inflammation lasting less than four (4) weeks
- Chronic sinusitis: Inflammation lasting 12 weeks or longer
- Recurrent sinusitis: Four separate episodes of acute sinusitis in the same year but symptoms between episodes
- Pansinusitis: Inflammation of all the sinuses at the same time
- Other: When the documentation identifies a specific type but there isn’t a code to adequately describe it
- Unspecified: When the documentation fails to provide enough detail to assign a more specific code
- Look for the codes that match the documentation
- Always include the secondary code to identify infectious agent from (B95–B97) to identify infectious agent.
Many patients who have had this type of condition have needed both providers to perform treatments. Example: A case of low-grade fever, pain in Maxillary, spread by the time the patient was diagnosed for treatment. It included the removal of the infected tooth, drainage and IV antibiotics. Then the ENT provider needed to operate thru the nasal cavity to clean the frontal bone as a scaling, to remove the buildup of calculus. It is amazing how similar the procedures are and the knowledge that two amazing doctors were able to help a patient who had been so sick, and others could not diagnosis her.
So, as this single, common treatment demonstrates, it is easy to see where dentists and physicians can find way to collaborate and improve outcomes for a wide array of common patients, and both receive reimbursement from the patient’s insurance.