If you or someone you know suffers from a heart condition, you probably already know just how difficult it can make juggling the treatment and care for other conditions throughout your life. Some cardiovascular patients may even avoid seeking treatment from anyone other than their cardiologist, including seeking dental treatment.
Unfortunately, avoiding dental care as a cardiology patient may have some severe repercussions based on studies potentially linking poor oral health and cardiovascular disease.
The connections and treatment of patients with cardiovascular disease in dental care is a fine balance between medications that a patient may be taking, their overall health, and providing the best possible dental care. But, what are the connections between oral health and heart conditions, how can appropriate dental hygiene help, and can medical insurance be billed for dental treatments in cardiovascular patients?
What is the link between periodontal disease, overall oral health, and cardiovascular disease?
Government agencies and researchers alike have continued to investigate the potential link between periodontal disease, oral health, and cardiovascular disease. Some studies even show that the bacteria in the mouth that are found in the development of Perio (periodontal disease) can shift into the bloodstream, causing an increase in C-reactive protein, which is a marker for the inflammation of blood vessels. It is these changes that can increase the overall risk of stroke and heart disease in patients with poor oral health.
There are ongoing studies to either prove or refute the connection between the two, no matter the relationship, it makes a point of just how important it is to maintain optimal oral hygiene as an important component of overall health in the patient.
Keeping Medication Lists and Medical Histories Updated
At the beginning of each visit, it’s important to review the patient’s medical history and medication list. It is here that a dental professional will learn about any medications the patient is taking and health conditions that the patient suffers from. Keeping this information updated on a frequent basis is incredibly important in ensuring that the patient’s overall health is adequately documented for treatment and medical billing purposes.
Patients should try to get these histories updated after any medical occurrence. Taking the steps to communicate with dental providers is an incredibly important step in helping dental practices provide the best oral health care possible. Having an updated list of medications and personal conditions can dictate how the overall treatment of the patient is handled and can also impact billing medical insurance for dental treatments in cardiovascular patients since medical billing requires a thorough health history to prove the necessity of treatment.
A patient who is taking blood thinning medication following a stent placement may have to delay their dental treatment or will have to get permission from their cardiologist to stop taking their medication for a short period of time so that their oral treatment can be completed.
Another common situation found when treating cardiovascular patients is dry mouth caused by medications. A dry mouth can lead to tooth decay and a slew of other oral health complications that need to be treated with care. If a dental provider isn’t told about medications or comorbidities, it can make treating the symptoms much more difficult.
Fortunately for most dental professionals and their patients, treating cardiovascular patients is a relatively common occurrence and can be done safely if their patient is open and honest about any medical conditions and medications that they are taking.
What Cardiovascular Diseases Require Extra Care When Treating Oral Health?
While this list isn’t all-inclusive, there are a few cardiovascular diseases that pose an especially high risk of complications during dental treatments. When the heart is involved, it is important that both cardiologists and dental professionals are kept in the loop about the overall health and care of the patient.
Heart Attack (Myocardial Infarction):
It is suggested that you wait at least 6 months after a heart attack (MI) before undergoing any extensive dental treatments. If there is a dental emergency, the cardiologist and dental professional can collaborate to ensure the safety of the patient during treatment.
With that said, there is no reason to delay maintenance appointments with a dentist. Dental cleanings and follow-up visits are generally safe for any cardiovascular patient and can help to prevent any problems caused by new medications that the patient may be taking.
Medical Billing Opportunity: Patients that have heart disease or history of a heart attack, may be at increased risk of complications, if they have periodontal disease or other active infections. For this reason, medical insurance may cover certain types of perio treatment, endodontic procedures, extractions and other treatment to remove infection. Make sure you have clearly documented the patient’s heart condition, and coordinate with their PCP or cardiologist to obtain the appropriate ICD-10 diagnosis codes.
People who are at risk of developing an infection in the lining of the heart must take extra care in practicing good oral hygiene on a daily basis.
These patients may even require antibiotics before having dental work done if they are at the highest risk of developing bacterial endocarditis after treatment.
Dental professionals and cardiologists will usually work in tandem to treat patients in the high-risk category to ensure that the appropriate oral hygiene routines are being followed.
Medical Billing Opportunity: If the patient is unable to maintain proper oral hygiene and the risk of infection is a concern of the dentist and cardiologist, medical insurance could potentially cover the costs of more frequent or involved hygiene treatments.
Patients on Blood Thinning Medication:
Anticoagulants and Antiplatelet medications can pause extensive dental treatments. The major reason for this delay is the fact that they can cause excessive bleeding during some oral surgery procedures and cleaning.
In these situations, patients and dental professionals will work with a cardiologist to prevent unnecessary risk during routine and emergency visits for dental care.
Hypertension (High Blood Pressure)
Some antihypertensive medicines can cause an alteration in taste or dry mouth. Calcium channel blockers can also cause gum tissue to overgrow and swell, which may lead to problems with chewing.
In these cases, a dentist will typically provide the patient with detailed oral hygiene instructions and may prescribe more frequent dental cleaning appointments.
In extreme cases, a gingivectomy may also be necessary to remove excess gum tissue.
Medical Billing Opportunity: If the patient needs more frequent or more involved hygiene visits or a gingivectomy or similar procedure, medical insurance may cover these services. To increase success of medical billing, the medical correlation must be documented in the clinical notes, and appropriate ICD-10 codes used to show the medical conditions.
Chest pain, also known as angina, is also sometimes treated with calcium channel blockers, which means that they are also at risk of overgrown gums and dry mouth.
Typically, patients with stable angina will have no issues with dental treatment, while those with unstable angina should consult with their cardiologist before undergoing any nonessential dental procedures.
Billing Medical Insurance for Dental Care for Cardiovascular Patients:
Just like any other comorbidity, patients with cardiovascular disease may qualify for billing medical insurance, depending on the treatment plan and proven necessity to prevent further complications with the heart.
It is important to keep well-documented notes of your patient’s medical history, the reason for the treatment, and if the medications that the patient is taking is causing dental degradation. Working with the patient’s physician is essential when treating cardiovascular patients as not only will they provide the ICD-10 diagnosis code, but a referral letter or letter of medical necessity can increase the probability of coverage exponentially.
The Imagn Billing Team is standing by to help you in finding the appropriate cases to bill to medical insurance and how to use medical codes to bill medical insurance for dental care in cardiovascular patients!