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.