It is not possible to report tooth numbers in the 837 professional transaction for MEDICAL claims.   This is principally a wisdom tooth issue but also relates to traumatic dental injuries that fall under the coverage umbrella of a medical carrier. This specificity is also needed for coordination of benefits to allow a primary medical carrier to report tooth specific information to a secondary dental carrier.

These types of claims are filed by Oral and Maxillofacial Surgeons. Oral and Maxillofacial surgery is a recognized specialty of both the medical and dental profession.  It encompasses the surgical and related treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the head, face, mouth, teeth, gums, jaws, and neck. Practitioners in this discipline hold a DDS degree or both a DDS degree and an MD degree.

There are about 7000 Oral and Maxillofacial Surgeons in the United States. Clearly more than 90% of the offices file both medical and dental insurance claims. The average Oral and Maxillofacial Surgery practice treats 1600 patients per year. The mix of medical and dental claims varies based upon the local and regional variations in plan design for impacted wisdom teeth. Based upon surveys of Oral and Maxillofacial Surgeons, Oral and Maxillofacial Surgery offices typically average 30% medical claims. It has been estimated that there are 1,512,000 total submitted claims filed reporting impacted wisdom teeth to medical carriers per year.

Because of geographic variation and new plan designs, many Oral and Maxillofacial Surgeons are reporting to the American Association of Oral and Maxillofacial Surgeons (AAOMS) that dental plans are often requesting denials from the primary medical plan before considering the dental claim for impacted teeth. This coordination of benefit issue is one of the driving forces for the need for this line item specificity of tooth numbers so that medical and dental carriers can adjudicate claims properly.

This estimate does not include all the claims submitted to the industry by dentists for accidental injuries to natural teeth, which would also be reported as medical claims. It also does not include full mouth extractions on medically compromised patients that require extractions submitted to medical carriers for covered services for transplants, heart valve surgery, chemotherapy, and pre head and neck radiation therapy for cancer patients.