Dental Coding: What You Need To Know To Keep Your Practice Compliant

practice systems Nov 01, 2018

Compliance with regulations is important in nearly every industry. But the confusing Current Dental Terminology (CDT) coding can make life difficult, especially when you’re navigating all the other complex issues you face while running your practice.

CDT codes are constantly changing and they aren’t always easy to understand. However, it’s essential that you learn as much about dental coding as possible if you want to ensure compliance and keep your billing process as seamless and straightforward as possible.

I understand what can happen when you don’t learn about how to navigate CDT codes. That’s why I’m dedicated to educating others about this important topic so that they can maximize their legitimate reimbursement and minimize the risk. It may be a difficult topic to understand, but CDT coding is one of the most important issues affecting your practice.

Background On Code Changing

In the early 2000s, there was a dispute between the insurance industry and the American Dental Association (ADA) as to which entities should have control over coding for billing purposes. After a lengthy back and forth, which culminated in a court case, it was decided that a committee would be formed with representation from the insurance industry and the ADA. When the committee was initially established, it included six members: three representatives from the dental industry and three from the insurance industry. Because the committee was split down the middle, there was almost always a deadlock on decisions related to code changes.

Things changed in 2012 when the timeline on the court decision that formed the committee ended and the process was reassessed. Today, there are far more representatives from the ADA than there are from the insurance industry. Until 2012, almost no code changes were passed by the committee. Since it was reassessed and the representation was changed, there have been more than 320 code changes. The dramatic shift in the composition of this code committee makes it imperative that dentists keep updated code books that include the latest changes.

Codes are submitted to the committee for consideration for many different reasons. Anyone, regardless of their role in the dental industry, can submit a code change request to the committee for consideration. Often, businesses that produce specific dental tools submit codes to ensure their products will be covered by a specified code accepted by insurers.

Difficulties Of Dental Code Reviews

There are still plenty of reasons why the committee could deny or delay a code request. One of the most common requests is for laser therapy. Laser therapy is commonly used in dental procedures, including scaling and root planing.

Over the last several years, I’ve seen codes specifying laser therapy submitted, reviewed and not adopted nearly every year the committee convenes. The primary reason is that codes are meant to specify procedures and not the use of specific tools. We have codes that specify root planing and scaling that cover the procedure whether it’s done with a laser or any other tool. Many of these codes offer broad coverage, which gives practices the ability to use their discretion in their tool selection depending on what’s best for the patient.

It is important to remember that this committee is not set up to handle instantaneous changes and provide immediate results. Codes that will be reviewed at next year’s committee have already been submitted, and changes will not go into effect until the following year. In other words, it takes three years—give or take a few months—for a code to go through the entire review, approval and implementation process.

Working With Existing Coding Procedures

One of the most difficult aspects of dental coding is the fact that there is often overlap into medical coding. Maintaining two separate departments—one for medical coding and one for dental coding—can be complicated and costly. In the future, I believe that dental coding will be a thing of the past and our existing codes will be integrated into a single medical coding system. However, as long as we have dental coding, we must learn how to navigate the relevant terminology and procedures.

To successfully bill for treatments and procedures, it’s essential that you think about whether what you are doing is medically necessary. I like to say that the magic word is “justified”. If you want a successful billing process, you need to make sure that your care is justified based on the standard of care you have to uphold. With that in mind, you must find a way to justify the procedures you are doing with any evidence available.

To do this, you and your time must be on the same page and have a thorough understanding of which procedures are considered justified. You must know the requirements, understand what insurers will consider during their review and refer to your updated code book to confirm whether you are making the right calls. No matter how well you adhere to the codes and follow procedure, it’s important to keep comprehensive documentation. I always advise dental practices to keep good records so that they can support their decisions and reference documents in the event of an audit.

Mastering the coding process requires a commitment to continuous learning. Dental coding, as it exists today, likely won’t be around forever, so you should make sure that you are educated on the current process and prepared for the changes that will take place in the near and distant future.

Dr. Roy Shelbourne graduated with honors from Virginia Commonwealth University’s School of Dentistry in 1981 and set up a practice in his grandfather’s old hardware store. After 27 years of practicing, he became the subject of a healthcare fraud investigation. He was found guilty of his charges and spent 19 months in prison.

In the wake of his arrest, Dr. Shelbourne became aware of the huge importance of documentation and billing codes. Upon his release, he committed his life to ensuring that no other dentist was the subject of an investigation due to a misunderstanding about complex billing and coding procedures. Today, Dr. Shelbourne is a speaker, consultant, writer and coach who supports medical professionals with valuable advice, guidance and information to keep them compliant.

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