Thursday, April 13, 2017
Other than patients, there is likely nothing more important to a dental practice than getting paid. Most businesses would likely agree—a successful business requires paying customers.
In dental care, however, you may have patients, but the entirety of their payment doesn’t always rest in their hands because payers are likely involved. Thus, if your dental insurance claims are not properly coded, you’re going to have some problems with the latter part of the equation for business success.
Claims are a tricky mechanism to manage. They’re a complicated beast that can easily confound the unprepared coding professional. Herein lies the rub: The coding landscape is constantly changing, with new codes added each year to track another area of regulation or payment reform.
Changes to insurance codes were abundant in 2017, as they have been for the last seven or eight years. With the number of changes in dental care, managing codes is a large-scale undertaking, especially because of the possible impact these changes can have on a practice.
How to manage the ever-changing field of dental codes
Teresa Duncan, president of Odyssey Management Inc., a Maryland-based dental consultancy that serves clients nationwide, is an expert in dental codes. She constantly monitors the changes and educates the community as to their effect on a practice. She is an ardent proponent of practices being aware of the coding changes and how they will affect services provided, as well as the possible impact on the first-time claim adjudication.
Coding changes translate to important updates for the dental sector. Each year, Duncan conducts coding consultations and hosts Web classes designed to translate the changes and their impact on the practice.
Why the constant code changes?
The Code Maintenance Committee meets yearly to discuss and make changes to current dental codes. Unlike in the medical field where codes change only once every so often—like the recent transition from ICD-9 to ICD-10—dental codes are evolving all the time.
New CDT 2017 procedure codes:
- D0414 - laboratory processing of microbial specimen to include culture and sensitivity studies, preparation and transmission or written report
- D0600 - non-ionizing diagnostic procedure capable of quantifying, monitoring, and recording changes in structure of enamel, dentin, and cementum
- D1575 - distal shoe space maintainer – fixed unilateral
- D4346 - scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluationThe removal of plaque, calculus and statins from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. Should not be reported in conjunction with prophylaxis, scaling and root planning, or debridement procedures
- D6081 - scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant surface, without flap entry and closure
- D6085 - Provisional implant crown
- D9311 - consultation with a medical health care professional
- D9991 - dental case management – addressing appointment
- D9992 - dental case management – care coordination
- D9993 - dental case management – motivational interviewing
- D9994 - dental case management – patient education to improve oral health literacy
“There’s beginning to be more of a focus on moving toward diagnostic coding where coding is used to describe treatment and why it’s needed rather than just what the dentist did for the patient,” Duncan said.
Codes are required to justify procedures and to track behavioral health of the overall population. For example, dental practices now have codes for their Medicaid patients indicating whether the patient received behavioral or education counseling. There are also codes referring to whether a patient missed an appointment.
The code changes suggest a stronger focus on case management, Duncan said. More work is being done through coding to track abuse of benefits (in Medicaid), and to address overall population health for patients, but this is not always easy for practices.
Electronic solutions improve claim adjudication
Another impact on codes is claim attachments, which are highly misunderstood. More documentation is needed for patient procedures even for the most basic care, with code changes driving this effort. Through her work with practices, Duncan estimates 75 percent of claims now require an attachment as supporting documentation. These attachments are meant to help tell the narrative of the care provided to the patient so the payer will approve the claim for payment.
Without painting this picture, coding professionals will have less of a chance of moving paid claims through their revenue cycle, Duncan added, which means longer tracks without revenue for the practice. This is complicated further when practices choose not to move from a paper-based system to a secure electronic attachment environment.
If this is you, you are being left behind. There is little reason to feel threatened about the process of this change. Most payers are moving to electronic claim submission and payment models. Because of this, technology is driving the annual coding changes. Those practices that continue previous-generation processes only create obstacles for themselves.
Dental code changes are likely not going to stop, which is probably a good thing, Duncan argues, but the change still requires copious work and much time to track and process, whether you’re using an electronic attachment solution or not.
The list of 2017 dental coding changes is serious business as you can see from the chart below. For additional assistance in understanding these changes, you can view Duncan’s free 2017 coding update webinar course, "2017 Coding Update" webinar, presented by Duncan and hosted by NEA Powered by Vyne.