Billing of dental services pertaining to functional analysis: tooth wear diagnosis and billing

Progressive tooth surface loss unrelated to caries or trauma has been an increasing focus of dentistry over the last several decades. New clinical diagnostic procedures had to be established to address this problem. Established procedures for the measurement and classification of tooth wear and its pathological relevance for the individual patient now exist in the form of a two-stage examination procedure comprising tooth wear screening followed by an in-depth tooth wear status assessment, if indicated. This was not taken into account in the 2012 update of the German Dental Fee Schedule (GOZ), whose list of functional diagnostic services remained largely unchanged compared to the previous version of 1988. The German Dentistry Act, on the other hand, requires dentists to practice dentistry in Germany according to the current state of science. Dentists would be unable to meet the requirements of the German Dentistry Act if limited solely to the services listed in the GOZ fee schedule. Therefore, legislators drafting the new GOZ fee schedule gave dentists the option to bill for independent services not included in the fee schedule commensurate with the fees charged for analogous services of similar type, cost, complexity, and time requirement. Based on the example of tooth wear screening and tooth wear status assessment, this article describes the legal and scientific background as well as the consequences of implementing the GOZ 2012 fee schedule in daily clinical practice. Keywords: temporomandibular dysfunction (TMD), tooth wear, tooth wear screening, tooth wear status assessment, fee schedule, GOZ, analogous billing