Canada Lab Fees

For Canada users, in the Procedure Codes list, double-click a procedure code.

Lab fees can be charted in Open Dental and associated with a procedure code. The default lab code is 99111, however other codes can be used.

To ensure a procedure code is considered a lab, check Is Lab Fee in the Edit Procedure Code window.

Attaching Lab Fees to Procedures

Labs should be attached to a procedure code prior to sending a claim.

There are two ways to associate a lab with a procedure.

  1. Add the lab fee directly to the procedure code.

    Double-click on the procedure code, then click the Canada tab. Type in the lab amount. You can add up to two lab fees.

    Note: If the carrier supports version 04 eClaims, both fees are sent. If the carrier supports version 02 eClaims, then only one lab fee is sent.

    This will automatically create the 99111 procedure code.

  2. Manually attach a lab fee.

    Chart the procedure and the lab procedure code separately. Once both are charted, in the Chart Module, highlight both the procedure and lab, right-click on either code, and select Attach Lab Fee.

    This will attach the lab fee with the procedure. Use this method if you are using a custom lab procedure code.

When a lab is attached to a procedure code, a visual indicator of ^^ will appear in the description.

Removing Lab Fees

To remove a lab fee, double-click the procedure, select the Canada tab, and clear out the fee. Alternatively, delete the lab procedure separately.

Lab fees can also be detached from procedures by right-clicking the lab procedure in the Chart Module and selecting Detach Lab Fee.

Appointments

Lab procedures will show on a separate line in the Appointments Module. The lab amount calculates into production.

Insurance Estimates

Lab fee estimates are based on the coverage of the associated procedure.

Overrides to estimates must happen on the procedure rather than the lab.

When the insurance plan is a Category Percentage plan, the percentage will be applied to the total of the procedure and attached lab fees. Example: 50% coverage. Procedure fee is $100. Lab fee is $10. Estimate = (100 + 10) * 50% = $55

To use the same insurance estimate logic for PPO plans, enable the Canadian PPO insurance plans create lab estimates option from Account Module Preferences.

Claims

Lab procedures should be attached to the related procedure before submitting on a claim. If the lab procedure is a custom procedure code, printed and electronic claims will show only the first 5 characters, but EOB printouts will show the custom code as it shows in Open Dental. Claim Acknowledgments do not display lab procedures.

Lab procedures will show in the Edit Claim window. The lab fee will show as a separate line item.

On a printed claim, the lab will show on the same line item as the procedure.