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Lara Coseo
Lara Coseo, Dentist (DDS or equivalent)
Category: Dental
Satisfied Customers: 212
Experience:  Awarded, licensed dentist with over 13 years experience
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KATZ....had a tooth extracted 2 weeks ago r/t

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HI Dr. KATZ....had a tooth extracted 2 weeks ago r/t infection....it was #31, right side....had an old root canal without crown....in March, #30 was extracted and prepped with PRF for a mini implant which has not been done yet.....I had 12 hours of bleeding after that extraction....with the one extracted 2 weeks ago, the Dentist said he was going to pack it with Collagen to try to reduce the post extraction bleeding and he sutured it.....I have to have non EPI numbing and as you know it wears off quickly...I WAS THERE...I know what he did...I am also an RN which makes me an awful patient....lol...He extracted the tooth, scraped away as much infection as possible ( I had been on Amoxicillin for a week already and still having pain and swelling)....packed with Collagen and Sutured....I still bled for 12 hours.... I was in so much pain when I left, I just paid the bill and ran to the drugstore for Vicodin....when I looked at the bill later, I see a $180 charge for Bone Graft for Ridge Preservation...when I called the office to ask about the charge, she said it was for hemostatic dressing (Collagen)...the next person said the Collagen is a type of Bone Graft.....I remember her asking about "180" which is their billing code for Bone Graft and he said no, it was just to try to help with bleeding....and may help with some healing of the bone....but, it didn't work.... still bled for 12 hours....am I getting jerked around.?????... When I had #30 extracted, they billed it as a Surgical Extraction...Insurance wouldn't pay....IT WAS NOT A SURGICAL EXTRACTION...again..I was there....he pulled it .... it had broken off so he pulled it in 2 parts.....then used the PRF and Sutured it.......they DID rebill it with the correct billing code.....insurance said unless he used a knife, it was NOT surgical ...no knife was used....this is one if the top Dentists in this area....especially for mini implants....
I was going to him several years ago and we had a run in because he was insisting on doing planing and scaling of my lower
teeth...I told him I didn't want it done....he had done the right side and was so painful I refused the left side and he told me that would be malpractice if he didn't do it... I told him no...I , as a patient, have the right of refusal...he explains the pros and cons and I have the right of refusal...so, he said he would not be able to take care of me...so, I got out of the chair and left ...!!!... Then I had 2 Dentists retire...😞😞 and I wanted a mini implant on #30 and he is the best in this area. .was considering going back to him for all of my dental work but, can't do it if he keeps trying to pull the rug out from under me...so, my question is, was that Collagen a Bone Graft or a Hemostatic Dressing....from what I have read, Collagen is used to COVER a Bone Graft...but, can it actually be billed as a Bone Graft.

Good afternoon! It looks like Dr. Katz is unavailable at this time. Would you like me to help you? If you'd prefer to wait for Dr. Katz, I will opt out of this question.

Sincerely,

Dr. Lara

Customer: replied 1 month ago.
You can answer
Customer: replied 1 month ago.
I am about ready to cancel this whole thing.....just please answer my question....I am not paying anymore for anything.....if you cannot answer, just let me know and we will call it a day....

Okay, thank you for being flexible! It sounds like you have a very complicated situation going on here.

As far as the collagen vs. bone graft issue goes, here are my thoughts. There are some types of grafting materials that contain both bone particles and collagen. For instance, the brand I use is called NuOss, and they make many different products for grafting. There is one product in particular . . .

Sorry, I cut that one short so you would know that I am in the process of answering. I'll continue...

One of their products contains both collagen and bone particles and is called a collagen block. It offers the benefit of dimensional stability that the particles alone do not. The reason I tell you about this product is that there is a very small chance your dentist used something along these lines that could technically be counted as bone grafting.

However, if zero bone particles were contained in what was placed into the socket, then it would not count as a bone graft.

Is there any way you could find out the brand name of the material they specifically used on you? Then I could tell you for certain.

To address your question about the bleeding:

There are a few different factors that could contribute to increased post-op bleeding. If the tooth was very infected, all of the granulation tissue that builds up around an infection brings a lot of blood supply to the area. This would cause prolonged bleeding. Since I don't know exactly what happened during the extraction, I can't verify exactly what caused the prolonged bleeding.

For the issue of surgical vs. non-surgical extraction:

In most realms of dentistry, an extraction is considered surgical if the tooth does not come out in one piece. This usually means that it will involve the use of a drill, a chisel, a scalpel, etc.... So technically, I do not agree with your insurance company's assertion that only a knife constitutes a surgical extraction. But they are the ones paying, so they can make restrictions as they like.

Does that answer your question?

Dr. Lara

Customer: replied 1 month ago.
Nothing was mentioned by the Dentist as BONE GRAFT....in March, they drew blood and spun it down and used the Plasma to prep for a mini implant to be done 6-8 m ontgs later....at that time, he wanted to extract #31 as he said it might interfere with the implant as the roots did not look good but decided to LEAVE it and do Antibiotic therapy every 2 months to see if #31 could be saved....he wanted to extract it and NOT replace it as the tooth above was not functioning with #31 in the chewing process. When it became infected 3-4 weeks ago, he just decided to extract it.....because ...I am typing.....hold on ..I will finish
Customer: replied 1 month ago.
When he extracted it last week, he just said he was going to put Collagen in to help control the bleeding....as I had had 12 hours of bleeding with the last extraction....then I get a$180 bill for Bone Graft for Preservation...1st person tells me the Collagen was hemostatic dsg....second said it was Bone Graft...I am not buying bit as I heard him tell the asst.... it was to control bleeding...can you use JUST COLLAGEN PACKING FOR Bone Graft....

No, you cannot use just collagen packing for bone graft.

I am looking up the dental insurance code for bone graft to get more detail for you.

Okay, the official insurance code does have the words "non-osseous graft" in it, so I think there is a little wiggle room for the practitioner there. However, the purpose of a socket graft is for preservation of the jaw bone "clinically indicated in preparation for implant reconstruction or where alveolar contour is critical to planned prosthetic reconstruction". So if you have no plans to replace that tooth, no ridge preservation is needed.

Does that answer your question?

Dr. Lara

Customer: replied 1 month ago.
Okay....thank you....that is what I thought.....I had billing problems with him the LAST visit when they billed for a Surgical Extraction and he did a simple extraction....had to change the code.....it matters where insurance payments are concerned.......they told me that my insurance would not pay for the Graft....thank you for your advice.....sorry for the delay....my phone had to be plugged in and I couldn't find you....it threw me out...go figure...again thank you

No problem! I'm happy to help. Do you have any other questions for me?

Dr. Lara

Customer: replied 1 month ago.
No...I don't think so....just needed a second opinion .....

Okay, good. Let me know if you have any further questions.

Thanks for using JustAnswer!

Sincerely,

Dr. Lara

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