Hi StephanieNBS!
Great questions.
1. What would the correct code/code-range be for the appointment where we deliver the oral appliance, make adjustments if needed to improve fit/comfort, give patients instructions on use, and discuss a follow-up home sleep study in 3-4 months to evaluate appliance efficacy?
For the large majority of medical insurers, you will actually not bill out for any office visits from the delivery date through 90 days of follow up care, as they are considered included in the reimbursement for HCPCS code E0486, which stands for a custom made oral appliance used to treat airway collapsibility (i.e. Medicare, Aetna, etc).
2. We see the patient for a series of appointments after the appliance is delivered. Normally, we schedule appointments 2 weeks and 4 weeks after delivery to discuss with the patient how appliance is going, see what changes they are having thus far (e.g. sleeping better, feeling better, etc.), address any problems, adjust protrusive advancement for the first time, answer any questions patient may have. What would the correct code be for these visits?
For the 2 and 4 week appointments, those would fall into the 90 day "global period" included in the reimbursement for E0486, so would not be billed for most medical insurers. If you do run across an insurer that does not include 90 days of follow up care in E0486 (which is not often anymore, but not unheard of either), then yes you would bill established patient office visit 99211-99215 for those visits, depending on the complexity of the visit. Generally a 99211-99212 for most dental practices.
Another question I have--I understand that there are different E&M codes for new vs. established patients. I was told by a dentist who runs a dental-to-medical billing company that a "new patient" would be considered any patient who we have not seen for sleep apnea before, even if we have seen the patient for other dental services. But, based on coding definitions I find in my cross-coding book and online, it sounds like patients would be considered established if they've been seen at our office before, no matter the reason. Can I please get confirmation on this too?
I agree partially with the dentist you spoke with. For evaluation & management office visits, the rule is if the patient has not presented to your practice within the last 3 years for a medical visit, then they are considered a new patient. If they have been to your practice within the last 3 years but for a purely dental visit, you will need to create a new medical chart for the patient and collect a medical history, etc, so that would be considered a new patient office visit (99201-99205).
Hope this helps!