Claims and coding are of the utmost importance to practices. Money powers every business, fuels growth, and affects our ability to serve prospective clients, whether they be patients or software customers. One thing is true for businesses large and small -- without a well-managed revenue cycle -- success, although possible, will be fleeting at best.
For dental practices, one key to a well-managed revenue cycle is claims management. Getting a claim paid the first time it is submitted is critically important to managing practice revenue. Given the overwhelming number of changes that bombard the code landscape in dental care, this can be a difficult undertaking, especially with the level of detail these changes encompass and the potential impact they have for a practice.
How can you stay on top of coding changes?
One of a practice's most powerful assets is the expertise of a quality coding professional who, if used as a partner, is able to bring some clarity to the process of coding. Teresa Duncan, president of Odyssey Management, is an expert in dental codes and constantly monitors their changes. She believes that practices must be aware of coding changes and educate their office staff accordingly to ensure that changes to code sets don't result in decreased first-time claim adjudication.
The industry's regular coding changes bring important updates each year. So much so that Duncan makes a habit of conducting annual online classes designed to distill the code tweaks and updates to her clients, industry insiders, and coding professionals at hundreds of practices throughout the U.S.
Why the constant code changes?
The dental 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, according to Duncan.
"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," she said.
Codes are required to justify procedures and 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 also are codes referring to whether a patient missed an appointment.
"On the Medicaid side, they want to see what procedures we're providing and how often," Duncan said.
There is a strong sense of hope that advanced coding methods can help track abuse of benefits, but really these coding tweaks are meant to address overall population health and improve case management for patients, according to Duncan.
"On the medical side there is a lot of case management. On the dental side, that hasn't happened," she said. "Really progressive offices provide care, but as an industry, we haven't achieved that yet."
The issue at hand is comprehensive care and providing a better picture of oral health. But this picture comes with pain -- and not necessarily for the patients. A lot of it is felt at the practice level.
Electronic solutions improve claim adjudication
In addition to coding changes, which are difficult enough to track, Duncan said she sees a lot of confusion about payor networks and receives many queries about claim attachments. More documentation is needed for patient procedures -- even for the most basic care. She estimates that about 75% of claims now require an attachment as supporting documentation. The use of claim attachments now mostly involves submitting narratives, radiographs, periodontal charts, intraoral photos, and basically any supporting documentation that helps paint a picture for payors so that they will approve the claim for payment.
Without creating a good picture, there's little way for a practice to be paid in a timely manner. This is especially difficult for those practices that choose not to move from a paper-based system to a secure electronic attachment solution, Duncan said.
"Some dentists say they'll only move to electronic attachments when they are forced. When I ask them why, they have no good answer to that," she said.
Some see a move away from manual paper processes to technology-driven, electronic solutions as a threat. What they should see are solutions that will help them be more efficient, improve their revenue cycle, and enable more face-time with patients.
Payors are moving to electronic claim submission and payment models, just as technology is driving the annual coding changes. Those practices that continue trying to make a go of things while operating in the past are only creating obstacles, not to mention opening themselves up to security risks.
People sometimes think paper is more secure because "no one can steal my data," but how secure are stacks of paper charts, letters left out for the mail, or documents sent and left on fax machines for anyone to pick up walking by? Just because the data isn't digital doesn't mean it can't be stolen or lost.
Despite the ever abundance of changes to dental codes, there's nothing that's likely to stop these changes to the dental landscape, and that's probably a good thing. But, it still requires copious work and much time to track, codes being as important as they are to the health of business at a practice.
The list of 2017 dental coding changes is serious business as you can see from the chart below.
|New CDT 2017 procedure codes|
|D0414||Laboratory processing of microbial specimen to include culture and sensitivity studies, preparation and transmission of written report|
|D0600||Nonionizing 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 evaluation|
|The removal of plaque, calculus, and statins from supra- and subgingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis -- 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 healthcare 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|
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