Most dental offices will tell you that dental billing and coding can be complex and time consuming. Adding ICD-10 diagnosis codes for dental medical billing into the process may seem to make insurance billing an even more challenging task. However, ignoring a billable medical diagnosis code will result in money left on the table -- not -- building practice revenue. It also impacts patients. By not cross coding dental and medical insurance, you may be preventing patients from receiving the full range of their benefits.
Much like dental billing, medical billing relies upon coding for medical procedures. Medical codes, or Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System or HCPCS are used for medicine while Current Dental Terminology or (CDT) codes are used for dentistry.
ICD-10 is a billable diagnosis code that dentists use for specifying a medical diagnosis. The American Dental Association (ADA) further defines it “as the only diagnosis code set that may be used on claims submitted to dental benefit plans when needed”. ICD-10 codes may “also be used on claims for dental services submitted to medical benefit plans where diagnosis codes are always required."
What are Medical Codes for Dental Procedures?
To ensure proper patient records and prompt payment from dental insurers, getting CDT codes correct is essential, though it can be complex. As a result, it ends up being a time-consuming process for many dental practices. Whereas CDT codes provide information about in-office procedures, ICD-10 codes provide information about a diagnosis. While many dental practices have not widely adopted ICD-10 coding, you may still be required to to use them when filing with certain payers.
ICD-10 stands for International Classification of Diseases, 10th Revision and provides codes for a diagnosis rather than a procedure. Medical doctors are currently required to code using ICD-10 and, as a standard promoted by both the World Health Organization (WHO) and HIPAA, there’s already a place on ADA forms for the same information. In short, it may only be a matter of time before ICD-10 codes are required on dental claim forms as well.
It’s worth noting that ICD-10 is remarkably robust with over 68,000 entries that are very specific, down to the first and second occurrences. As one can imagine, this coding could likely become both more important and more challenging.
The Importance of Medical Codes for Dental Billing
As noted above, dental codes for dental billing are required to communicate with insurance providers regarding the service and procedures received by patients. As part of the billing process, dental offices must include the CDT codes so insurance providers will reimburse the office.
Coding accuracy, be it dental or medical codes for dental billing, is vital. First, those codes are essential for patient care and continuity of that care. Further, CDT, CPT, HCPCS and ICD-10 codes are a means of communication between dental practices and insurance providers. If mistakes are made, even if unintentional, claims can be, at best, delayed and, at worst, considered fraudulent.
The Importance of Medical Billing for Your Dental Practice
For many dental practices and organizations, 50% of their revenue comes from insurance payments. When 50% of revenue comes from one stream, ensuring that stream is consistent and reliable is essential.
Ensuring that revenue stream means, for many, maintaining a dedicated staff member to attend to insurance verifications and ensure every step of the dental billing process is completed accurately, including coding. The problem most dental practices face is that dentists often aren’t sure which codes to use given that there are thousands of ICD-10 codes from which to choose.
Identifying the right tools to help your team is crucial.
Dental Coding Challenges for Dental Organizations
When it comes to dental coding, there are a few key challenges. First, clinical information required for dental coding often has to pass through many hands from clinicians and technicians to the dentist and then to administrative staff. The patient-specific information can include a wide variety of data sources from clinical notes and charts to x-rays and radiographs. With a heavy schedule and potential staffing issues, the volume and variety of the data may present challenges to efficiency and accuracy.
Additional challenges to coding include:
- Coding updates- CDT, CPT, HCPCS and ICD codes are updated on a annual basis.
- Lack of sufficient codes- Whether it’s a new procedure or a modification, sometimes the CDT code doesn’t match the procedure
- Human coding errors- Let’s face it, people make mistakes, especially in a busy office
Given the full-team effort as well as the type and volume of information needed to ensure the accuracy of billing and coding, dental offices and organizations will want to leverage every tool available to them, especially with ICD-10 codes. The right dental coding software solution will not only ensure the accuracy of dental billing and claims, but also help save time and effort, especially when it comes to securing your revenue stream.
How Medical Cross Coding Impacts Dental Practice Success
Obviously, finances are important, but when it comes to the other impacts cross coding can have on dental practice success, it’s essential to look at efficiency and patient care. The more your team is tied up and focusing on administrative tasks, the less time they have to spend on customer service and client care. While dental coding issues can create revenue stream issues, failure to deliver the care and service your clients want and deserve can be even more detrimental.
Alleviating those challenges is what drives the team at iCoreConnect and why our suite of healthcare workflow solutions is designed to assist your team with their daily work and help your practice meet its growth goals. If you’re ready to see how dental practice software can help you increase your overall efficiency and remain HIPAA compliant, book a demo today!