CBU's: Document your diagnosis and bill with success

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When performing a crown procedure, one crucial step that ensures the long-term success of the treatment in some cases is the core build-up. However, the decision to perform a core build must be well-documented, especially when submitting claims to insurance providers. This blog will guide you through the essential guidelines for requiring a core build for a crown, how to document the need before, during, and after the appointment, and the steps for submitting to insurance and following up on claims.

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Table of Contents

1. Understanding the Core Build-Up

2. Guidelines for Requiring a Core Build

3. Documentation Requirements   

4. Insurance Submission

5. Follow-Up After Submission

6. Best Practices for Smooth Insurance Processing

1. Understanding the Core Build Up

A core build-up is a dental procedure performed to repair a tooth before placing a crown. It involves adding material to the tooth structure to ensure there’s enough foundation for the crown to fit securely. Without a proper core build, the crown may not adhere correctly, leading to potential failure of the treatment.

2. Guidelines for Requiring a Core Build Up

Assessing the Need for a Core Build Up

Not every tooth requiring a crown will need a core build. However, when a significant portion of the tooth structure is missing due to decay, fracture, or previous restorations, a core build may become necessary to provide adequate support for the crown.

Common Scenarios Requiring a Core Build Up

• Extensive Decay: When the decay has compromised a large portion of the tooth, making it unstable without reinforcement.
• Fractured Tooth: A tooth with a fracture extending beyond the crown portion may need a core build to restore its structure.
• Previous Restorations: Teeth that have undergone extensive restorations, such as large fillings, may lack the structural integrity to support a new crown without a core build.

3. Documentation Requirements

Proper documentation is key to ensuring a smooth insurance submission process. It also serves as a record of the clinical decisions made during the treatment.

Diagnostic Documentation

Before the appointment, document the patient’s dental history, including any previous restorations and current conditions. If you are replacing a failed crown, you will want to document the date of the original placement. Include diagnostic tools such as periapical X-rays, intra-oral photographs, and descriptive notes that indicate the need for a core build up

Crown Preparation Documentation

During the appointment, document the clinical findings that reinforce the need for the core build up, such as the extent of decay or the condition of the tooth structure. Include details of the materials used and the steps taken during the procedure. Take X-rays and intraoral photos during the prep if applicable. It is always good practice to take a photo of the core build up after it is placed, as much as photos of the prep tooth before the build is placed that showcase crack-lines in the floor of the prep, etc.  

Crown Seat Documentation

After the appointment, document the final restoration details, including the type of crown placed, what material was used to place it permanently, and any additional procedures performed. Include that the size, shape, and fit were verified. This documentation will be crucial when submitting the insurance claim and in case of any follow-up inquiries.

4. Insurance Submission

Preparing the Claim

When submitting a claim for a core build up and crown, ensure that all documentation is complete and accurate. Include the clinical notes, X-rays, and any other diagnostic images that support the need for the procedure. Clinical. notes should clearly state the reason for the core build and how it was necessary for the success of the crown. 

If your office submits on crown prep date - you may have some core build up denials for companies and plans that pay on seat date. This is normal, and the claim should be left open until the core build up is paid. If you submit all procedures on seat date, have an internal process that insures no crowns will be lost pertaining to submitting them to insurance. 

Myth: Core build-ups denied due to inclusivity, and in general  are not appealable

With the proper documentation as listed above - all denied core build ups should be resubmitted or appealed. 

For instance, when dealing with Cigna, it’s important to note that they require the seat date of the crown to be reported in order to pay the build up. A simple phone call to report  the seat date of the crown will ensure most core build ups are paid. 

5. Follow-Up After Submission

Monitoring Claim Status

After submitting the claim, monitor its status regularly. Many insurance companies provide online portals where you can check the progress of the claim. If the claim is pending, review the reasons and provide any additional documentation if requested.

Addressing Denials or Additional Requests

If the claim is denied or if the insurance company requests additional information, respond promptly. Review the denial reasons carefully and resubmit the claim with any necessary corrections or additional documentation.

6. Recap: Best Practices for Smooth Insurance Processing

Accurate Documentation: Ensure that all clinical notes and documentation are thorough and accurate to support the need for the core build throughput the entire clinical and insurance billing journey.

• Timely Submission: Submit claims promptly after the procedure and include all required information.
• Regular Follow-Up: Monitor claims regularly to catch any issues early and respond quickly to any requests from the insurance company.
• Communication with Patients: Keep the patient informed about the claim status, especially if there are delays or if additional information is required such as  an original placement date for replacement crown. Typically, and coverage parameters for crowns will also apply to the core build up as it can only be billed in conjunction with a crown.

If you or your team are struggling with knowing what attachments should be included with common procedures, be sure to utilize our dental claims attachment cheat sheet in our free downloads.

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