12.18.15 Issue #719 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Belle DuCharme, CDPMA
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CDT Coding Changes Ring in the New Year
By Belle DuCharme, CDPMA

If you aren’t already using the ADA 2012 version of the dental insurance claim, you should start in 2016. Very few insurance companies will still accept the 2006 claim form, no matter how comfortable you are with using it. There are changes on the 2012 form that are necessary to support claim adjudication, especially when it comes to diagnosis coding.

Many general dentists shake their heads and say “this won’t affect me.” There are more policies coming into the marketplace that have an embedded dental policy in the medical policy, giving the patient the benefit of both for their dental care. There are also policies that, with the use of certain codes, trigger a denial asking the provider to bill the medical carrier first. That is why it’s necessary to indicate the existence of medical coverage on the claim, whether you intend to bill it or not. When filing these claims, it will be necessary to understand the ICD-10-CM diagnostic codes. These codes were just introduced on October 1, 2015 to replace the ICD-9 codes.

Let’s put that aside for a moment and look at the Current Dental Terminology for 2016. Some dental software will update your standard fee schedule to include the new codes, but will not inactivate the deleted codes or make revisions to existing codes. For the most part, updating code changes in your database is a manual task. Studies show that only a fraction of the available dental codes are used because the dental team just isn’t aware of the changes. While dental plans are required to recognize the current CDT codes, they are not required to pay them. Because of the proprietary nature of the ADA codes, I am not at liberty to list them in this article; please go to the ADA website and purchase the CDT for 2016.

Insurance companies will start paying for new codes when they see they are actually being used and there is a demand that they pay from the consumer. It is important to know there are 39 new changes to the Current Dental Terminology in 2016. These changes include 19 new codes added to the CDT.

There is now a code for an occlusal guard adjustment (for treatment of bruxism). In past versions of the CDT there was never a specific code for this procedure, which resulted in many dentists either billing with a report code “999” that requires a narrative, or not billing at all and it was a courtesy to the patient. The new code can be reported when adjusting any type of occlusal guard, but not on the day of delivery. Usually after the delivery of the occlusal guard there are a certain number of adjustments that are included in the initial purchase. The number is determined by the dentist, or if in-network with the insurance company, there will be policy limitations. After that period of time is over, the adjustment can be billed with the new code. It is important to remember any appointment that takes a sterile setting, a chair in a room, trained staff, time and materials should be charged to the consumer. 

Another exciting addition to coding is the new code for “Interim caries arresting medicament application.” The use of silver nitrate in combination with fluoride varnish and silver diamine fluoride are two common medicaments used today to arrest active asymptomatic carious lesions without the removal of sound tooth structure. Previous to this new code, there wasn’t any code available to use. Please note to not use this new code to report fluoride varnish.

There is also a new code for “Extra-oral posterior dental radiographic image” for both dental arches. For patients who cannot tolerate intra-oral placement of the sensor for bitewing images, this may be necessary. There previously wasn’t a code available to accurately describe this procedure.

According to Insurance Solutions Newsletter September/October edition, “an average of 25 procedure codes represents 95% of the practice revenue for most practices.” Learning to make even modest use of newer codes or using the existing codes correctly can add to the practice revenue without having to increase most used codes beyond market acceptance.

Need help navigating in the precarious world of dental insurance? Call McKenzie Management today for our 2-day customized business training course.

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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