Dental Billing Compliance: Guidelines for Billing Core Buildups

The American Dental Association gives specific definitions for various procedures, which dentists must follow when billing dental procedures. One of the most narrowly defined procedures is a core buildup. The circumstances in which dentists are allowed to report core buildups are laid out in great detail here but can be summarized into three major categories.

Red Light
Non-negotiable billing errors that could trigger an audit or nullify your contract with an insurer in addition to non-payment include:

• Performing a core buildup just to improve aesthetics of the tooth structure when it’s not needed for the tooth to support a crown.
• Billing a separate procedure for a crown and buildup when using a one-piece such as Cerec® or E4D® fabricated crowns.
• Reporting a core buildup as a direct amalgam/composite restoration. Any fillings placed shortly before the crown prep may be deducted from crown reimbursement, as the restoration is considered a “take back.”
• Using a core buildup in conjunction with an inlay or onlay rather than a crown.​

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Yellow Light 
Practices which insurance companies may not cover or may require additional justification such as:

• Reporting a separate core buildup under the retainer crown of a bridge. This buildup is included in the single bridge code and does not require separate coding.
• Separately billing any pin used in a core buildup. The core buildup procedure code includes the use of pins.
• Reporting a core buildup when opening access for internal bleaching is not payable.
• Some payers will not reimburse a core buildup on a vital tooth, but only consider core buildups in conjunction with crown preparation.
• Some payers require a specific timeframe from the start of treatment to crown placement in order to justify a core buildup.

Green Light  
Dental Billing Best Practices to Ensure Reimbursement:

• Always include a narrative when reporting a core buildup.
• Preauthorize and schedule crown placement as soon as the core buildup is started, as some payers require crown placement to reimburse the buildup.
• If a core buildup is performed, but the patient doesn’t return for the crown, re-file the claim with an explanation for why the patient did not complete the proposed treatment.

If the above guidelines seem confusing, our specialized endodontic dental billing professionals can help. Give SB Dental Billing Solutions a call to find out more.