ࡱ> ;=:%` bjbjNN . ,,      Z\\\\\\$h~   ~~~F  Z~Z~~~  @<!: 0"~T0~w R"w ~w ~ ~  t  d   May 15, 2009 Phillip A. Wenk, DDS President and CEO Delta Dental of Tennessee 240 Venture Circle Nashville, TN 37228-1699 P: 800-223-3104; P: 615-255-3175 F: 615-244-8108 Re: Letter from Dr. Henry Ramer and the LANAP Procedure Dear Dr. Wenk, We are writing about the above referenced letter we recently became aware of regarding the LANAP procedure. Dr. Henry Ramer, Vice President of Professional Relations, Delta Dental of Tennessee (DDTN), wrote a letter dated April 14, 2009 to Dr. Michael Skinner, a practitioner of the LANAP protocol. (See enclosed) In pertinent part Dr. Ramer wrote: I have received your newsletter where you reference Delta Dental and benefit re-imbursement for Laser Periodontal Therapy. By CDT definition, the 4260 and 4261 code are for osseous surgery which includes flap entry, osseous re-contouring, and closure. As the LANAP procedure [sic] does not involve osseous re-contouring, it would be improper to use these codes for this procedure. DDTN considers LANAP to be part of any periodontal scaling and root planning. This letter is problematic at a number of levels, but it is especially concerning to us, as the inventors of the LANAP protocol, for it false description of the LANAP protocol. The LANAP protocol is a surgical protocol that involves a flap entry, modification of the bone at the time of surgery, and wound closure. Those are the ADAs requirements for 4260 and 4261. It is troubling that Dr. Ramer and DDTN would write a letter that is prospectively biased against a treatment where understanding of the treatment by Dr. Ramer and DDTN is incomplete, misunderstood, and misrepresented. Furthermore, it is troubling that Dr. Ramer and DDTN did not write in denial of a claim submitted by a clinician who rendered appropriate patient treatment, who chose the most appropriate ADA code and descriptor, with any appropriate narrative, and after a proper claims adjudication process, but about a newsletter announcing the clinicians professional services. This letter appears to be an improper attempt by DDTN and Dr. Ramer to prejudice Dr. Skinner and preemptively deny re-imbursement to his patients outside the terms of the contract between the carrier and the employer, from any clams he would submit for the LANAP protocol. A recent letter from Joseph F. Hagenbruch, D.M.D. Chair, Council on Dental Benefit Programs at the ADA to Dr. Thomas McLellan Director, Professional Services Delta Dental Plan of Michigan, Ohio and Indiana provides specific guidance germane to Dr. Ramers letter to Dr. Skinner and the LANAP protocol (See enclosed letter): Nomenclatures for dental procedure codes D4260 and D4261 contain the following salient text: osseous surgery (including flap entry and closure)" This wording is meant to preclude separate reporting of flap entry and closure when they are components of the osseous surgery procedure performed by the dentist. Dental procedure codes D4260 and D4261 are used to document an osseous surgery procedure that "modifies the bony support of the teeth by reshaping the alveolar process to achieve a more physiologic form." If a dentist performs this procedure, then these codes are applicable. (Underline emphasis added.) Whether or not LANAP procedures do, in some cases, modify the bony support of the teeth is not a coding issue, but a scientific and procedural issue. (No emphasis added). Therefore, we feel that it inappropriate to pre-determine what a clinician may decide to do in advance, based on the name of the protocol, not what the dentist actually accomplished during the treatment visit. We would appreciate a review and reconsideration of Dr. Ramers letter, its contents, representations, and DDTNs claims adjudication process with respect to the LANAP protocol, Dr. Michael Skinner and any other clinician practicing the LANAP protocol and submitting claims to DDTN. Professionally yours, Robert H. Gregg, DDS Delwin K. McCarthy, DDS 9Qc 0 1 2 `ghnIKLSNOPQfͿwp h <hh7/h <CJaJh h <5CJaJh <5CJaJh7/h <>*CJaJh h <CJaJ!h?h <B*CJ^JaJphh <B*CJ^JaJphh?h <CJaJhEh <CJaJhdfh <CJaJh <CJaJh < h <CJ%'9Sf a b 2 3 $h]h^a$gd <gd <gd < JKfg9:UVWmnopq$h]h^a$gd <gd <,1h/ =!"#$% 8`8 <Normal_HmH sH tH 8`8 < Heading 2$@&CJ DA@D Default Paragraph FontRi@R  Table Normal4 l4a (k@(No List '9Sfab23  J K f g 9:UVWmnopq00000000000000000000000000000@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@002Z00@0 00   8@0(  B S  ?q&r&ds&lXt&$u&v&-w&,Xx&dy&z&{&-|&\#}&#~&4&ܟ#&#IISSffqu~~>>h      RReeosAAk  > *urn:schemas-microsoft-com:office:smarttags PostalCode: *urn:schemas-microsoft-com:office:smarttagsStreet9*urn:schemas-microsoft-com:office:smarttagsplace8 *urn:schemas-microsoft-com:office:smarttagsCity9*urn:schemas-microsoft-com:office:smarttagsState;*urn:schemas-microsoft-com:office:smarttagsaddress ^6    !$ . z ) 4 33-b <3WhUpW6NRR&y3af ?[ox"KIJw% - 9 I [L 9 & 5 by  _U d3 r 2 ?e ,G3ws0: oGbYe*.8=5(6S1]"N-> t 8)In&_9:8  YECoI |7nZg.F? F yz Vs!v!w!K ":"<"l"W####L#l#$ $3%$:&$(w$d0%#;%I%f%K &v&'R-'i'())m)o)*o*7(+F+K+}_,6"-.-P-S. /$,/Z/ 1?5?@C@-X@P2AwYA]A5ByYB~wBCC CUC;oCxC)D3D;DijDB}DmERsE F+FHFgFGAO MO9vO%QQQIQLQ&XQ[QdQ3RCRJFRnIRSCSe^S>TaFTU0wU VhV5pV|VT=WEWS3X=X:DXh[X{XEY(YkBY2jYvmY ZLZ#ZuRu uuu^v_ v=v|Jvt"w%wDSw@xIIxuxy*yKyVy_yy_zT#{|$|1|[=|4q|}q~?X|D-BXR_~@ sw%Lyi r@Iy- Q%Eqn=8w;~$ k&CR12Y7$ DJ$Um*0=Y 0JC[%@:DF\u8|hnB\m?y-)SI%lMZewa;KYxd JT";Qk 1_g2N R+KKPS/04=FP 4Z=swTyi 1 =VJJ8Hga7>2 ! Mc}i E]*jt@/MgIh^sQt\pkI{u;p *\RIok} 2ec0L|Xdrp} ^ tg "<V<=Rr/0_q|1tj$]|3?_/aDqn~MzRpU5$,MNRdK&(ME@\y]W|12cGSNNb%)= `Yi{{RZW\b jm_+HVI-~@v4&8R0`:AEG13ji"R\ 5A@Ceyazr U1I*}kpq`O&*2b*0ClrE#=&;1:l:oxF!=>Kvu"%)0D?^A'Vvx W"n"$g@a c7,MQw?J TF`MA8Wp'hO}c m5ImMNVP]3judZFIN`|iv# M"$,~{.hcv~dKd=qVy {Oz'g]DEaF%6 f my0y0@k4p@UnknownGz Times New Roman5Symbol3& z Arial"qhUN UN !24d 2qHX)? <2 May 15, 2009Robert H. GreggRobert H. GreggOh+'0 $ D P \hpxMay 15, 2009Robert H. Gregg Normal.dotRobert H. Gregg1Microsoft Office Word@G@ :@c!:UN ՜.+,0 hp   Millennium Dental Technologies'  May 15, 2009 Title  !"#$%&'()+,-./013456789<Root Entry F0pF!:>Data 1Tablew WordDocument. SummaryInformation(*DocumentSummaryInformation82CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q