Augmentation of bony defects due to loss of teeth using bone-grafting materials is a common procedure performed by general dentists, periodontists and oral surgeons. When billing bone grafts, it is necessary to use the most up-to-date codes, while avoiding unlisted, unspecified and nonspecific codes. In addition to selecting the right CDT code, dentists have to also report the correct ICD-10 code to indicate the diagnosis. Further, as medical insurance reimburses for oral surgeries, with knowledge about cross-coding, dental offices save dental insurance and help patients get needed treatment. Working with an experienced dental billing company is a practical strategy for dentists to manage the billing and coding process and maximize reimbursement.
When Bone Grafting is Necessary
Bone grafts are used in combination with endodontic, oral surgery, implants and periodontal procedures. Bone loss in the jaw due to loss of teeth can cause atrophy of remaining alveolar bone, leading to chewing and speech problems, soft-tissue pain, muscle dysfunction, and lack of bone for tooth implants. Bone grafting is usually performed in the following situations:
- After tooth extraction to limit the amount of hard- and soft-tissue loss
- Before dental implant surgery to replace a lost tooth
- To build the jaw before dental implant placement
- When bone loss affects neighboring teeth
- For reducing bone loss caused by periodontal disease
- To correct trauma or surgery defects
- General alveolar deterioration
There are various types of bone grafting material options:
- Autogenous – the tissue is taken from the patient undergoing the graft procedure
- Non-autogenous: the graft is taken from donor other than the patient (allogenic, alloplastic, allograft and xenograft materials)
After the procedure, the bone graft will support bone healing and regeneration, and add volume and density to the jaw.
CDT Codes for Bone Grafts
The CDT codes for graft procedures are found in the Endodontics, Periodontics, Implant service and Oral & Maxillofacial surgery service categories. Dentists need to report the correct CDT code to describe the grafting procedure that the patient underwent.
The CDT codes for bone grafts are as follows
- Bone Graft for Endo/Periradicular Defects
D3428 Bone Graft in Conjunction with Periradicular Surgery – per tooth, single site (includes non-autogenous graft material)
D3429 Bone Graft in Conjunction with Periradicular Surgery – each add’l contiguous tooth in same surgical site (includes non-autogenous graft material)
- Bone Graft for Periodontal Defects
D4263 Bone replacement graft – retained natural tooth – first site in quadrant
D4264 Bone replacement graft – retained natural tooth – each additional site in quadrant
- Bone Graft for Periimplant Defects
D6103 Bone Graft for Repair of Periimplant Defect
Note: This is for grafting a bone defect around an existing implant, and does not include flap entry and closure. Placement of a barrier membrane or biologic materials to aid in osseous regeneration should be reported separately.
- Bone Graft When Placing Implant
D6104, Bone Graft at Time of Implant Placement
Note: This is for bone grafting around an implant at the same time the implant is placed. The placement of a barrier membrane, or biological materials to aid in osseous regeneration is reported separately.
- Bone Graft for Ridge Augmentation in Edentulous Site
D7950 Osseous, Osteoperiosteal, or Cartilage Graft of the Mandible or Maxilla – Autogenous or Nonautogenous, By Report
Note: It includes obtaining autograft and/or allograft material. Placement of a barrier membrane, if used, should be reported separately. This is not a graft done in an extraction site or implant removal site.
Reporting Graft Material Acquisition
There are CDT Codes with descriptions that state that:
- the procedure includes graft material acquisition
- the graft material is acquired as a separate procedure and reported with the appropriate code
➤ Procedures where Material Acquisition and Graft Placement are separate
Graft Procedures Not including Obtaining Graft Material – The following CDT codes explicitly state that the procedure does not include harvesting or collecting the graft material:
D7950 Bone Replacement Graft for Ridge Preservation – per site
CDT descriptor: “Osseous autograft, allograft or non-osseous graft is placed in an extraction or implant removal site at the time of the extraction or removal to preserve ridge integrity (e.g., clinically indicated in preparation for implant reconstruction or where the alveolar contour is critical to planned prosthetic reconstruction).”
Note: This dental bone graft code can be used when filling in the hole after the removal of a tooth or dental implant. It does not include obtaining graft material. If a membrane is used, it should be reported separately.
D7955 Repair of Maxillofacial Soft Tissue and/or Hard Tissue Defect
Note: Reconstruction of surgical traumatic or congenital defects of the facial bones, including the mandible, may utilize graft materials in conjunction with soft tissue procedures to repair and restore the facial bones to form and function. This procedure does not include edentulous maxilla and mandibular reconstructions for prosthetic considerations
➤ CDT Code for Graft Material Collection Only
D7295 Harvest of Bone for Use in Autogenous Grafting Procedures
Note: D7295 is the only code entry specifically for reporting acquisition of material used in a separate graft procedure. It is reported when hard tissue (bone) is collected from the patient who is also to receive the separate bone graft procedure.
➤ Graft Procedures that Include Material Acquisition
Graft Procedures including Graft Material Acquisition
There are 13 CDT codes for procedures where the descriptor states that the acquisition of the graft material is included and not to be reported as a separate procedure in a claim. For e.g., the following procedures include graft material acquisition in general terms:
D4277 Free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant or edentulous tooth position in graft
D4278 Free soft tissue graft procedure (including recipient and donor surgical sites) each additional contiguous tooth, implant or edentulous tooth position in same graft site
D7943 Osteotomy – mandibular rami with bone graft; includes obtaining the graft
D7951 Sinus augmentation with bone or bone substitutes [The augmentation of the sinus cavity to increase alveolar height for the reconstruction of edentulous portions of the maxilla. This includes obtaining bone or bone substitutes. Placement of a barrier membrane, if used, should be reported separately].
D7952 Sinus augmentation via a vertical approach
With the multiple CDT codes involved, documentation of graft procedures can be confusing. Insurance companies will reimburse bone grafts only if they are medically necessary for the success of the procedure being performed or when normal healing cannot be expected to eliminate the bony defect (www.aetna.com). Further, dental insurance verification is necessary to understand patient coverage as each benefit plan has different rules as to which services are covered, which are excluded and which have dollar caps or other limitations. Therefore, it is recommended that the practice sends out a pre-treatment authorization to ensure a smooth claim determination process. Partnering with an experienced provider of dental billing services is the best way to meet these requirements.
Using the correct dental codes to appropriately report various procedures to insurance companies is a major concern for dental practices. For certain procedures, dental offices are required to bill a patient’s medical plan for dental procedures that are typically considered “medical” in nature. The submission of dental treatments to medical payers – referred to as dental to medical cross-coding – can seem complex. The good news is that dentists can ensure accurate submission of dental procedures to patients’ medical plans with the help of a company with expertise in providing both medical and dental billing services.
Dental Procedures that can be Billed to Medical Insurance
Oral health impacts general health. By billing medical procedures, dentists are treating the patient’s overall health, while also improving reimbursement. Medical insurance reimbursement is available for common procedures that dentists perform when the services meet medical necessity considerations. Dental procedures that can be billed to medical insurance include:
- Dental repair of teeth due to injury
- Treatment related to inflammation and infection
- Certain periodontal surgery procedures
- Consultation for and excisional biopsy of oral lesions
- Consultation and treatment for temporomandibular joint problems
- Infection that is beyond the tooth apex and not treatable by entry through the tooth
- Pathology that involves soft or hard tissue
- Procedures to correct dysfunction
- Emergency trauma procedures
- Appliances for mandibular repositioning and/or sleep apnea
- Congenital defects
- Dental implants, bone grafts, and CT scans
- Clearance exams before chemotherapy or surgery
Dental and Medical Cross Coding: Requirements for Successful Claim Filing
- Use the Right Codes: There are standard codes sets for reporting medical and dental procedures in the HIPAA transaction sets. All HIPAA-covered entities are required by law to accept CDT, CPT and ICD-10 codes. Knowledge of CDT, CPT, HCPCS, and ICD-10 coding is crucial for successful dental and medical cross coding and billing. Dental practitioners need to report the correct codes to describe the treatment provided and why it was medically necessary in the medical claims. The clinical documentation should support all the diagnoses and procedures reported.
Key points to note when using CDT, CPT, HCPCS, and ICD-10 to submit dental procedures to medical insurance:
- CDT Codes: These codes are maintained by the American Dental Association. CDT codes identify oral procedures and are used to submit claims to dental plans. Many medical insurance companies accept the CDT code or HCPCS code if no appropriate medical cross code (CPT) is available or when the CDT is the most accurate code to describe the dental procedure performed. Most medical payers who allow submission of CDT codes require that only one dental or medical code be reported on each claim form.
- CPT Codes: Referred to as Level I codes, CPT codes are used to report medical procedures to medical insurance. CPT codes are maintained by the American Medical Association.
- HCPCS Codes: Referred to as Level II codes, HCPCS codes are basically used to report medical services, equipment, or supplies. Dentists use HCPCS codes to report durable medical equipment (DME) such as oral sleep apnea and temporomandibular joint disorder appliances. This code set is maintained by the Centers for Medicaid and Medicare Services (CMS). HCPCS codes are updated throughout the year.
- ICD-10 Codes: These codes are used to identify diagnoses, symptoms, and procedures in claims. ICD codes inform the payer why the procedure may be medically necessary. Every medical claim requires at least one ICD-10 code be reported and not including one will result in claim rejection. ICD-10-PCS (procedure coding system) codes are used only by hospitals in an inpatient setting. Dentists report only ICD-10-CM codes and not ICD-10-PCS codes.
- Verify Patient Coverage: Performing dental insurance verification is necessary to determine the type of coverage the patient has. If the patient has received dental care that is “related” to a medical condition(s), it may be possible to bill medical insurance. Before submitting the claim, the dentist needs to verify if the payer will accept CDT codes and other specifics of the insurance policy coverage.
- Know Which Plan (dental or medical) to Bill First: Many dental policies require the dentist to file claims for procedures that are considered medical in nature to the medical insurance first, before billing the dental insurance. An article in Dental Economics recommends holding the dental claim until the medical insurance evaluates it for payment of benefits. “At that time, the claim may be submitted to the dental payer with the medical explanation of benefits (EOB). Filing both medical and dental claims simultaneously may result in an overpayment requiring refunds to the payer(s) and/or patient”, notes the report.
- Use the Appropriate and Current Claim Form: Dental claims are reported using the 2012 ADA Dental Claim Form. Medical claims are reported using the CMS-1500 Health Insurance Claim Form (02/12). Whether submitting a medical or dental claim, it is critical to use the appropriate and most current version of the claim form. Tips to ensure clean claim submission:
- Use the correct codes
- Ensure the highest degree of specificity in clinical documentation
- Follow claim submission instruction precisely when submitting a medical claim
- Complete all the fields and ensure proper placement of required information
- Claims can be submitted in print format, electronic format or by mail depending on payer requirements. The most important thing is to ensure legibility
- Take care to avoid errors. An AGD Impact article reports that the most common claim errors are related to the use of punctuation (i.e., a decimal point in the ICD code), lack of a description when reporting an unlisted CPT code, and not using the appropriate modifier or qualifier, when required
Navigating the dental and medical cross coding process is much easier with the support of a medical billing company for dentists. Reliable companies will contact each patient’s medical carrier to determine their medical coverage. Their professional coding teams would be knowledgeable about the various code sets, which is crucial for proper cross coding. Billing expertise is also important for dental practices to stay up to date on new code changes and revisions that occur annually.
CDT codes or the Code on Dental Procedures and Nomenclature are meant to achieve uniformity, consistency and specificity in reporting dental procedures. Accurate documentation of dental treatment is possible with these specific codes.
According to the ADA (American Dental Association), CDT Codes are used for
- efficiently processing dental claims, and
- populating an Electronic Health Record
These codes are compiled by the ADA Practice Institute and experienced medical coding companies stay up to date with the changes in these codes.
What is the latest CDT code update?
ADA reviews CDT Codes annually to ensure that these codes can effectively report specific dental services provided. The latest 2021 CDT code changes by ADA include 28 new codes, 7 revised codes and 4 deleted codes. CDT 2021 codes go into effect on January 1, 2021.
With the recent pandemic at hand, the Code Maintenance Committee has added these procedure codes to CDT list 2021:
- D0604 – antigen testing for a public health related pathogen, including coronavirus.
- D0605 – antibody testing for a public health related pathogen, including coronavirus.
How to choose the right CDT code?
To choose the right dental procedure code to document the services provided, dentists and coders can rely on full CDT Code entry, published in the CDT manual. In the manual, certain procedure codes with their nomenclature are printed in boldface type and some entries come with descriptors printed in regular typeface. ADA has advised not to choose the codes based on reimbursement gained.
What is dental Code D0150?
D0150 Comprehensive oral evaluation – new or established patient
This code is used to report a comprehensive dental exam, where the dentist will be detecting early signs of illnesses that may be left undetected such as diabetes, oral cancer, leukemia, cardiovascular problems and more. A diagnostic treatment plan and an extensive evaluation assessment will be performed and diagnosis may include a periodontal screening as well.
Read our blog on “Coding the Dental Examination Visit Correctly”
What is CDT code D2950?
D2950 code is usually applied to teeth that do not have enough tooth structure to support a crown. It is important to submit clear documentation of the condition along with all supporting details to insurers to reduce core buildup claim denials.
Read more on “D2950” Dental Core Buildup Code
Reasons for Claim Denials Related to “D2950” Dental Core Buildup Code
Why Does “D2950” Dental Core Buildup Code Face More Claim Denials?
Dental Core Build-up – Handling Core Reimbursement Challenges
How are CDT Code and SNODENT related?
SNODENT is Systemized Nomenclature for Dentistry. CDT and SNODENT code set serve different purposes, but both are recognized by federal agencies to be used in the Electronic Health Records of dental patients.
||SNODENT (Systemized Nomenclature for Dentistry)
||Supports codified description of the patient’s condition/other factors that may affect treatment
HIPAA standard applicable to electronic dental claims
||Not a HIPAA standard and may not be reported on a dental claim
Are CDT Codes reported with ICD-10-CM codes?
Yes, for commonly occurring conditions. While the CDT Code is maintained by the ADA Council on Dental Benefit Program’s Code Maintenance Committee, ICD-10 is maintained by agencies of the federal government.
Some of the frequently reported CDT Codes and possible ICD-10-CM diagnostic codes given on the ADA website are
For Diagnostic, Evaluations and Exams
- D0120 Periodic oral evaluation – established patient
- D0140 Limited oral evaluation – problem focused
- D0150 Comprehensive oral evaluation – new or established patient
- D0210 Intraoral – complete series of radiographic images
- D0220 Intraoral – periapical first radiographic image
- D0230 Intraoral – periapical each additional film
- D0251 Extra-oral posterior dental radiographic image
- D0272 Bitewings- two radiographic images
- D0274 Bitewings- four radiographic images
- D0330 Panoramic radiographic image
- D0999 Unspecified diagnostic procedure, by report
- Z01.20 Encounter for dental examination and cleaning without abnormal findings
- Z01.21 Encounter for dental examination and cleaning with abnormal findings
- Z13.84 Encounter screening for dental disorders
Are there chances to get reimbursement only for fewer services than those reported on the claim?
There are chances that dentists may get an explanation of benefits (EOB) that includes reimbursement for fewer services or for different procedure codes than reported on the claim. In such cases, it is important to look at guidance in place regarding CDT Code use.
To avoid reimbursement issues and to maintain a strong dentist-patient relationship, ADA recommends that patients must be informed regarding the limitations of their dental plan prior to treatment. Dental insurance verification services can help dental practices to a great extent in verifying patient’s coverage before treatment and avoiding reimbursement denials or delays.
This could be the most relevant topic we are discussing amid this COVID-19 outbreak. Now, as most dental offices are closed, dentists can use telehealth systems to continue to serve their patients. As dental care, too, is necessary during this pandemic to maintain oral health, teledentistry is a great option to consider. During this worldwide crisis, if extreme measures like mass quarantines ultimately go into effect, this will be the only way patients can be seen by their dentists. With this remote dentistry option, dental care can be provided to those in need without exposing them to any unnecessary risks as well as extra expenses.
What Is Teledentistry?
The American Teledentistry Association defines teledentistry as “the use of electronic information, imaging and communication technologies, including interactive audio, video, data communications as well as store and forward technologies, to provide and support dental care delivery, diagnosis, consultation, treatment, transfer of dental information and education”.
With advancements in the dental industry, teledentistry has just recently gained the attention of the medical community. Teledentistry creates collaborations between dental hygienists, dentists, patients and caregivers.
A subset of telehealth, teledentistry facilitates dental care virtually. It works in such a way that, for instance – a patient takes a photo or video of their aching tooth and shares it with a dentist from a remote location, the dentist examines the image or video and determines the problem with the tooth, then, if necessary, prescribes medication to help with the discomfort until it heals or until the person can visit the physical office for a closer examination. A virtual consultation also allows a much safer approach to any questions a patient may have, giving them professional advice instead of searching the internet and possibly finding vague or improper answers to their concerns.
Another utilization of teledentistry works by using dental hygienists to see the patient in person and then relay feedback to the dentists over an internet connection.
Different forms of teledentistry include Synchronous real-time video (consultation using the video camera feature on phone, laptop, or other device), and Asynchronous recorded dental health information (documentation of dental health records like x-ray images or digital impressions sent via a secure electronic system). Remote monitoring (collecting personal dental health information in one location and transmitting it electronically to another provider for future treatment), and Mobile health (consultation via mobile devices such as smartphones, tablets, computers, and personal digital assistants) Both Remote monitoring and Mobile health options can be used in either Synchronous or Asynchronous situations.
The ADA recommends that the treatment of patients who receive services via teledentistry must be properly documented and should include providing the patient with a summary of services. Reliable medical billing companies can support dental offices with documentation and claims submission.
How Teledentistry Benefits Patients and Dental Offices
Remote dentistry provides diverse benefits such as –
- Patients have the opportunity to immediately address pain and soreness issues with the Dentist and upon the discretion of the doctor, receive an e-prescription to help manage the symptoms until the issue can be treated in office.
- Cost efficient, often times lower than the cost of an in-office fee. Also eliminates the price for transportation to and from an office
- Encourages those who may have anxiety with in-office dental visits to stay proactive in their oral healthcare from the comfort of their home
Increases the accessibility of dental care to those who have limited transportation options, disabilities, or even nursing home bound
- Specialists can consult with larger populations, improving specialty care
- Promotes the integration of dentistry into the larger health-care system. The telehealth industry has been established for some time now but is bound to play an even bigger role in the future.
A DentaVox survey on teledentistry done on October 2019 found that 78% of patients are likely to start using remote dentistry within the next five years and the top 3 groups who benefit from this service are working people, children, and people with disabilities.
Dental Insurance Coverage for Teledentistry
Currently in the US, teledentistry treatments are considered a covered benefit by select insurance carriers. Based on ADA’s statement on teledentistry, dental benefit plans and all other third-party payers, in both public (e.g. Medicaid) and private programs, shall provide coverage for services using teledentistry technologies and methods (synchronous or asynchronous) delivered to a covered person to the same extent that the services would be covered if they were provided through in-person encounters. Current dental benefit plan coverage and reimbursement provisions should apply to services delivered in-office and via teledentistry.
According to Dentistry Support, as of March 23, 2020, a list of current dental insurance companies that are covering Teledentistry procedures include Liberty, Metlife, UCCI, Aetna, Principle, Human, Guardian, Ameritas, Delta Dental, Envolve and Sunlife.
Teledentistry allows access to its services through programs such as Apple FaceTime, Skype, Facebook Messenger’s video chat feature, and Google Hangouts videochat feature. Examples of what’s prohibited via public-facing technologies include programs like Facebook Live, Twitch, and TikTok.
HIPPA compliance does not typically allow these forms of telehealth communication, but due to the COVID-19 pandemic, these select social platforms are currently available to further aid with remote patient care. A teledentistry event is subject to applicable state law, regulation or licensure.
CDT Coding for Teledentistry
A teledentistry event claim or encounter submission involves reporting the appropriate Place of Service (POS) code and CDT Code. Any Teledentistry code submitted must be reported in addition to another procedure (diagnostic code), as these are not standalone codes.
- POS code 02 (Telehealth – the location where health services and health related services are provided or received, through telecommunication technology) was added to that code set effective January 1, 2017.
Services provided in a teledentistry environment can be reported using D9995 and D9996 codes along with other diagnostic codes.
- D9995 teledentistry – synchronous; real-time encounter
Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.
- D9996 teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review
Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.
The appropriate code should be entered by the dentist who oversees the teledentistry event and who ultimately completes the oral evaluation. Applicable state regulations may also determine the oral health or general health practitioner who documents and reports these codes.
Any other procedures such as prophylaxis, topical fluoride application, or diagnostic images delivered during a teledentistry event would be documented and reported using appropriate CDT Codes by the dentist or other oral health or general health practitioner acting in accordance with applicable state law, regulation or licensure.
ADA recommends that a claim submission must include all required information as described in the completion instructions for the ADA paper claim form and the HIPAA standard electronic dental claim. However, coverage and reimbursement for D9995 and D9996 is likely to vary between commercial benefit plan offerings and by state for government programs (e.g. Medicaid). Dental billing services provided by professional companies must make sure they are also up to date with the changing teledentistry coding regulations.
Along with the rapid changes occurring in dentistry treatments, dental insurance, reimbursement rates, and rules and regulations are also changing. Dental billing services aim at submitting accurate claims to insurance payers and receiving maximum reimbursement. However, these claims may get declined or denied due to many factors. According to the 2018 National Survey from Bankers Healthcare Group (BHG), a leading provider of financial solutions for healthcare professionals, declining reimbursement rates is the top industry concern among dentists.
Bankers Healthcare Group (BHG) is associated with organizations that include the National Dental Association, the National Medical Association, the American Academy of Private Physicians, the Hispanic Dental Association and Operation Smile. This BHG survey highlights that nearly three-quarters (72%) of 413 licensed dentists, including both practice owners and independent practitioners indicated high levels of concern about this trend’s impact on the industry. Dentists were asked to rate their industry concerns and the top responses include:
- 61% highly concerned about the impact of DSOs/corporate dentistry, which was less likely to be a concern among younger dentists (42%) and more likely to be a concern among those practicing in a suburban office (71%)
- 49% highly concerned about increasing competition saturating the industry. This was more frequently cited by those practicing in an urban (53%) or suburban (51%) location and those aged 35-49 years old (54%)
- 43% highly concerned about government healthcare programs. This was more likely to be cited by younger dentists (51%) and those working in an urban office (48%)
Also, it was reported that one-quarter of those surveyed listed “Other” additional industry concerns, including the cost of equipment; availability of equipment; patients’ access to care; cost of education; and insurance. According to Al Crawford, Original Founder, Chairman and CEO of BHG, “Lower reimbursement rates mean dentists take in less income, so it’s not surprising that this was the most cited concern among the audience.”
Read our blog on key dental practice challenges you should know.
Patient education on insurance helps
While standard dental insurance covers cleanings, fillings and other routine care, major work like a crown or a bridge is often covered only at 50 percent and implants generally aren’t covered at all. As a result, people who require extensive reconstructive work often pay many thousands of dollars, or sometimes tens of thousands, in out-of-pocket expenses.
It is getting more critical for dental specialists to educate the public on the importance of their dental health and what current dental insurance covers. Educate people to view dental services as a necessity, not a commodity. Often patients will not be ready to undergo a dental procedure, if insurance doesn’t pay them for this specific treatment. An article in Workforce reports that 77% of the US population has dental benefits. Out of that 77%, 40% choose not to go to the dentist due to the costs and pain associated with their dental care.
An article in Dental Economics recommends dental practices to inform patients that dental insurance is not really insurance. It’s merely a plan that’s in place to help offset some of their dental expenses. Also, patients may refuse to have x-rays because dental insurance won’t pay for them. In such cases, hospitals can make them understand that a dentist cannot fix a tooth without seeing what’s going on ‘under the hood’ and so x-ray is important.
This article also explains some of the major changes occurring with dental insurance plans such as –
- Separate deductibles being applied toward preventive services in addition to basic and major services
- Plans that do not count additional benefit codes such as D0120, D1110, or D1120 toward the plan’s annual maximum
- Insurances that won’t pay at prep date, instead they reimburse based on seat date or completion date
- Decreased coverage on panorex x-rays and more
Along with educating patients with facts about how their oral health affects their overall health and the relevance of dental insurance to help offset dental expenses, it is also recommended to encourage patients who have insurance to use and maximize their benefits. The entire dental team must be trained on how to properly chart and code dental procedures.
While such insurance challenges are a part of their industry, dental providers may also have to deal with several major issues when it comes to filing dental claims and getting reimbursed at levels that actually cover the expenses of running a dental practice. Dental insurance verification solutions can reduce claim denials to a great extent by verifying each patient’s dental insurance prior to service within a dental practice.
The need for dental-medical cross coding is growing in dental practices as many dental procedures can be billed to medical insurance. Cross-coding dental to medical codes involves coding and submitting medically necessary dental procedures to insurance. Today, many dentists rely on an experienced dental billing company to implement cross coding for accurate claim submission, thereby increasing cash flow, improving patient care and satisfaction, and adding value to their practice. Medical billing for dentists and dental procedure codes are set to see many changes in 2017.
CDT 2017 features 11 new codes, five revised codes and one deleted code. Here are the new CDT codes that are eligible for medical cross coding:
- D0414, Laboratory processing of microbial specimen to include culture and sensitivity studies, preparation, and transmission of written report – This code relates to microbial specimens and can be used when diagnosing an infection. This implies that the lab processing may be covered by a patient’s medical insurance, if the lab is covered by the patient’s insurer.
- D0600, Non ionizing diagnostic procedure capable of quantifying, monitoring, and recording changes in structure and enamel, dentin, and cementum – Procedures covered by this code could be eligible for medical billing if the structural changes are related to a medical condition such as Gastroesophageal Reflux Disease (GERD) or bulimia or the side-effects of certain medications. Whether this diagnostic procedure is medical or purely dental would depend on the underlying causes of the changes to the teeth. It is therefore important to take a complete medical history of the patient to monitor changes to structure, enamel, dentin, and cementum.
- D4346, Removal of plaque, calculus, and stains from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis – This code may be used to report swollen, inflamed gingival and generalized suprabony pockets, in moderate to severe bleeding on probing. Treating gingival inflammation is especially important when patients have systemic diseases such as diabetes or heart disease. It may therefore be eligible for medical billing. Note: this code should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.
- D9311, Treating dentist consults with a medical health care concerning medical issues that may affect patient’s plan dental treatment – D9311 is generally used to indicate that the dentist is treating a systemic medical condition with oral effects rather than a purely dental condition. It aims to cover consultations with a patient’s primary care provider and other specialists. For e.g., as diabetes affects the gums and the gums affect diabetes management, dentists treating a patient with diabetes may want to collaborate with the patient’s primary care physician on issues related to blood sugar control, medications, diet, and exercise. Collaborative medical consultations can greatly improve a patient’s overall health and well-being.
- D9993, Patient-centered, personalized counseling using methods such as motivational interviewing to identify and modify behaviors interfering with positive oral health outcomes. This is a separate service from traditional nutritional or tobacco counseling.
- D9991, Individualized efforts to assist patients to maintain scheduled appointments by solving transportation challenges or other barriers – This meant to cover Medicaid patients so they do not miss appointments, and then show up in pain.
- D9992, Assisting in a patient’s decision regarding the coordination of oral health care services across multiple providers, provider types, specialty areas of treatment, health care settings, health care organizations, and payment systems – Providers can use this code to indicate the additional time and resources used to provide experience or expertise beyond that possessed by the patient.
- D9994, Individual, customized communication of information to assist a patient in making appropriate health decisions designed to improve oral health literacy – Explanations should be provided in a manner acknowledging economic circumstances and different cultural beliefs, values, attitudes, traditions, and language preferences, and adopting information and services to these differences. This requires spending more time and resources than that required for an oral evaluation or case presentation. Dentists should be able to communicate benefits and medical needs.
- D6085, to be used when a period of healing is necessary prior to fabrication and placement of permanent prosthetic. This code may be used when a patient who is healing comes for follow-up.
As regards dental implants, D6081 is a procedure that is no longer performed in conjunction with D1110 or D4910.
Many of the revised dental codes also impact cross-coding. Oral and maxillofacial surgeries are performed after traumatic injuries to restore normal function and these procedures are usually covered by medical insurance. Recently revised surgical codes in this category include D7140, D7210, D7250, and D7280. Due to the low caps on dental insurance benefits, patients with severe facial injuries receive higher reimbursement if dental offices bill through medical rather than dental insurance.
Learning about the 2017 CDT changes will allow dental offices to help their patients receive proper insurance coverage and also get appropriate payment for their services. Established companies that provide dental medical billing services are up-to-date on these medical billing and CDT updates for 2017. The best way for dentists to learn more about these changes and to make use of the opportunities for cross coding is to partner with a reliable service provider.