7.3.15 Issue #695 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Belle DuCharme, CDPMA
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The Future of Medical/Dental Insurance Coding
By Belle DuCharme, CDPMA

Documenting and coding of dental claims has been part of the dental office environment since the 1960s, and until recently hasn’t seen a lot of change. Today’s dental professionals need to prepare for the requirement of diagnostic coding for dental services. Dental diagnostic coding is already used in many university and large private dental practices using Electronic Health Records (EHR) and Electronic Dental Records (EDR).

In the past and at present, the use of the official Current Dental Terminology or CDT codes has been the hallmark of coding dental claims for payment by insurance companies. The CDT codes developed and copyrighted by the American Dental Association (ADA) have been the only acceptable form of coding used on dental claims. The new ADA 2012 dental insurance claim form has a section for medical diagnostic coding of the procedure codes. For billing medical insurance the CMS 1500 claim form is included in many dental software programs. HCPCS or CPT procedure coding system is the most commonly used coding system for reporting medical outpatient services and these codes are developed and updated annually by the AMA, American Medical Association. These codes provide a common billing language for payment of claims. 

When billing a dental service to a medical plan, you must find out from the medical insurance provider whether they will accept services using the current 2015 CDT procedure codes or the CPT procedure codes on claims. Usually in plans that have coverage for both on the same policy, the medical is billed first and if denied is then submitted to the dental plan. Many insurers are prepared for this confusion and have cross-coded to allow for this, however it is up to the dental provider to clarify before sending claims. Medicare and Medicare Advantage claims are in a separate category and not addressed in this article.

The change in the way things have always been done is the crossing over of some dental services into the realm of medical, creating a need for the same coding used in medical, diagnostic coding. Medical coding uses the ICD-9-CM Classification System to translate medical terminology into diagnostic codes. Presently this system is under transition to the ICD-10 codes set to launch in fall of 2015. 

To prepare for the use of medical diagnostic coding, dental offices must prepare to take far more detailed health histories on patients and details on observations of dental conditions. There may be more than one diagnosis for a dental disease or condition.  Getting in the habit of using Subjective, Objective, Assessment and Plan (SOAP) methodology of recording patient data will establish a system to collect the patient information to create proper diagnostic codes for dental/medical claims.

During an initial oral exam, data recorded includes conditions present and any previous dental treatment provided. Dental SOAP notes are written to improve communication by standardizing evaluation entries made in dental charts. Each letter in "SOAP" is a specific heading in the notes:

S – Subjective, the purpose or “chief complaint” of the patient’s visit. This section also includes the description of symptoms as conveyed by the patient: pain and what is triggering it, what causes the discomfort to disappear and the length of time these symptoms have been occurring.

O – Objective, unbiased observations by the dental team. Included under this heading would be things that can actually be seen, heard, measured, felt, smelled and touched.

A – Assessment, the diagnosis of the patient’s condition done by the dentist/clinician. The diagnosis may be clear or there may be several diagnostic possibilities.

P – Plan or proposed treatment is decided upon by the patient and the dentist. The plan may include radiographs, cone beam, biopsies and more tests, referrals to specialists or alternative treatments.

In SOAP notations, the usage of abbreviations is standard. If abbreviations are used they must be standardized to the practice and not obscure in meaning. Notations must be signed. If an error is made, a single line should be drawn through the error, dated and initialed, and the correction written. Corrections in computerized formats will vary according to dental software. Notations without blank lines between the entries will prevent additional information being added without the writer’s knowledge.

Change is here – embrace it! If you need help and training please call McKenzie Management and update your dental business skills today.

If you would like more information on McKenzie Management’sTraining Programs  to improve the performance of your team, email training@mckenziemgmt.com

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