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Dental-medical Cross Coding can Increase Dental Practice Reimbursement

by | Sep 22, 2016 | Medical Coding News, Resources | 0 comments

Dental billing has undergone a significant change over the years, especially since dentistry became the field of dental medicine. At one time, dentists treated patients and simply filed dental claims. Today, dental practices can bill their specialized services along with the patient’s medical insurance, which benefits them as well as their patients. Dental and medical insurance companies recognize that some dental procedures have a medical side to them and require the dentist to file the patient’s medical claim first. When performed correctly, dental-medical cross coding can increase dental practice reimbursement.

Cross Coding – Determine Medical Necessity

To successfully cross code, dentists need to know what can be filed medically and the right way to go about it. In cross coding, the most important consideration is the medical necessity to do so. Medically necessary means that the procedures must be in compliance with recognized medical standards, and appropriate and necessary for diagnosis or treatment, prevention of a medical condition, improvement of a condition, or for rehabilitation of lost skills.

The patient’s medical history form is a great tool to identify if the patient has diseases and conditions which could make the dental procedure medically necessary. Dental procedures that represent medical necessity include

  • Exams, radiographs and consultations for medically necessary dental procedures
  • Several oral surgical procedures
  • Excisions
  • Biopsies
  • Reconstruction due to trauma or genetics
  • Endodontics due to trauma or a medical condition
  • Temporomandibular joint(TMJ) procedures including treatment of myofascial pain conditions
  • Emergency treatment for oral inflammation
  • Non-surgical sleep apnea treatment

Patients with specific medical conditions:

  • Diabetes, heart disease, pregnancy, hormonal conditions, Parkinson’s disease, and Alzheimer’s disease
  • Need radiation treatment
  • Need a dental clearance before surgery
  • Medically necessary implant procedures (trauma, loss of teeth due to a medical condition, or patients with bone atrophy which results in dentures that do not seat correctly, causing problems with chewing and nutrition

The dentist should ensure that conditions determined to be medically necessary are part of the documentation in the patients’ records.

Points to note: Dental practices should take care to file cross coded claims only for those dental procedures that are medically necessary. Also, medical plans differ with respect to what they will cover. Procedures filed with a medical plan should not be filed along with with dental. Medically necessary procedures should be filed with medical as primary.

Ensure Accurate Claim Submission with Proper Documentation

Claims for medical procedures have to be submitted using the appropriate ICD-10 and CPT codes. Dental practices need to know how to use these code sets properly and communicate the procedures they performed to payers. For instance, the diagnosis codes chosen must have a proper connect to the procedures performed for dental treatment that is medically necessary and covered by the patient’s insurance. After the accurate codes are assigned, the claims must be submitted on the relevant medical claim form to meet the insurer’s guidelines.

Professional Dental Billing Services to Enhance Patient Satisfaction and Practice Revenue

Dental practices that implement dental-medical cross coding successfully can ensure optimal reimbursement benefits for their patients and themselves. Allowing a professional dental billing company to handle the task will ensure proper claim submission processes – from patient enrollment, dental insurance verification and medical/dental coding to billing and reconciling of accounts. Established companies have knowledgeable teams on the job which guarantees claim submission to comply with insurance standards, less denials, and more timely reimbursement.