CHICAGO--()--On January 1, 2013, Dentist Anesthesiologists were assigned a provider code by the National Uniform Claim Committee (NUCC). NUCC, chaired and hosted by the American Medical Association, is responsible for establishing national standards of content and data definitions for non-institutional health care forms in the United States. It also maintains the HCFA 1500 Medical Insurance Claim Form and specifies providers and data submitted on it.
“a dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years duration, in accord with Commission on Dental Accreditation’s Standards for Dental Anesthesiology Residency Programs, and/or meets the eligibility requirements for examination by the American Dental Board of Anesthesiology.”
Provider taxonomy code 1223D0004X defines Dentist Anesthesiologist as “a dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years duration, in accord with Commission on Dental Accreditation’s Standards for Dental Anesthesiology Residency Programs, and/or meets the eligibility requirements for examination by the American Dental Board of Anesthesiology.”
Dental Anesthesiology joins a classification of dentists that includes Dental Public Health, Endodontics, General Practice, Oral and Maxillofacial Pathology, Oral and Maxillofacial Radiology, Orthodontics and Dentofacial Orthopedics, Pediatric Dentistry, Periodontics, Oral and Maxillofacial Surgery and Prosthodontics.
The American Society of Dentist Anesthesiologists views this as critical in helping patients with intellectual and developmental challenges and young children with severe dental disease obtain insurance reimbursement for office-based anesthesia services. Most dentist anesthesiologists spend the bulk of their practice time providing general anesthesia/advanced anesthesia services facilitating dental treatment of children with severe early childhood caries as well as patients with special needs, from developmental and behavioral disabilities to Parkinson’s and Alzheimer’s Disease. Although it was previously possible to file insurance claims for these services, there was no way to distinguish the advanced training and services of the dentist anesthesiologist from other dental providers, frequently resulting in delay or denial of insurance reimbursement for these patients.
The new provider taxonomy code is expected to improve access to care. In Tennessee, for example, a licensed, board-certified dentist anesthesiologist applied to become a provider in the state Dental Medicaid program, but was denied because the program was “closed to new applications from general dentists.” Ironically, Tennessee ranks among the worst states in regard to dental health; lack of access to adequate office-based services often leads to patients seeking treatment in hospital emergency rooms, where the cost of care is dramatically higher than office-based care. 1