From time to time, your Tidewater Consulting team will share information via our blogs. These short, informative posts are designed to answer common questions, share relevant industry trends, and to strengthen and encourage the communities that we serve. The knowledge that is expressed in these posts represents 35 years of practical experience in medical / dental billing and coding, compliance, and administration of insurance. If there is a topic or issue you’d like us to consider please contact us.

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Coding can be complex and challenging at times. It is not to be taken lightly. The three things dental teams should know about up front about coding are discussed in this article. It has been my experience that there is very little reliable education about coding for dentists and dental teams.  So, I want to offer a starting point for your journey.

First, things first- Proper Coding Ensures Proper Reimbursement!

Coding is an area of compliance that is often overlooked in the dental practice. Documenting what we do and why we do it is crucial. A starting point is to understand the three overarching coding principles that apply to our profession.

Three Code Sets That May Apply to Dentistry

In dentistry the one code set dental teams are most familiar with is Current Dental Terminology known as CDT. CDT is the standard code set used to document dental procedures rendered to patients in a uniform fashion under the HIPAA act of 1996. CDT codes are also used to report procedures to third-party payers such as a dental or medical insurance plan for reimbursement consideration.

Sometimes, we find that dental procedures we perform in the dental practice are considered medical in nature and find it necessary to send a claim to a patient’s medical plan. These include procedures related to dental trauma, biopsies, sleep apnea appliances and much more. 

When submitting procedures to a medical payer, a Current Procedural Terminology code, known as CPT® is used to report the procedure. Sometimes the CDT code is reported when there is no accurate CPT code available to describe the dental procedure performed. Coding guidelines are that the provider is to use the code that most accurately describes the procedure performed. Sometimes, this is the CDT code. It takes a little training time and practice – but your teams can learn when to use CPT and when to use CDT.

One important gem I can offer is that while a CDT code may be reported to medical payers when appropriate, a CPT code will never be reported to a dental payer. 

Another standard transaction code set dental teams are not as familiar with is diagnosis codes. Diagnosis codes are utilized to establish medical necessity, the why. Why was the procedure required; what medical or dental condition are you treating? For many years in dentistry we have described why we perform procedures and what we do via narrative on a dental claim form. The good news is that we don’t have to narrate this anymore!  The ICD-10 CM is the code set used by physicians, dentists and other healthcare providers to document and report diagnoses. It has been in effect since October 1, 2015. There are currently over 73,000 codes, so yes there is a code for that! Whatever the condition you’re treating there is a code to describe it. 

Instead of attaching a lengthy word narrative to a dental claim we can utilize a diagnosis code in place of a narrative. This is a standard way of communicating the why of a patient encounter. And aids in adjudication or processing of the claim. 

It’s not enough to know the three codes. Each of these codes have guidelines that must be followed with them. Possibly the most important reference is that anyone reading the patient’s record should be able to recognize the code used as documented and understand what services were delivered and why the services were necessary. Our documentation tells the story of the patient encounter.  So, how do you do this efficiently and effectively as a practice? How do you know if all of your team knows how to tell the story?

Next Step

This can be challenging because all codes are reviewed and revised on an annual basis. Annual training of the entire team should be held prior to the effective date of the code, which is January 1 of each calendar year for CDT and CPT.  ICD 10 code set is also updated on an annual basis however it becomes effective October 1 of each year instead of January 1. You don’t have to go it alone, we’re here to help!

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