The cross-coding for dental and medical billing has changed the outlook. The discovery revealed that dental practices have optimized their revenue cycle management. Cross-coding seems mandatory because of the beneficiaries or insurance providers.
The process requires submitting dental procedures to a patient's medical plan rather than their dental plan when the treatment is medically necessary. Cross-coding involves translating CDT codes into CPT codes, enabling providers to bill medical insurance for specific procedures like oral surgeries, where medical plans cover treatments.
The practice has to file the medical claim first, although every dental procedure has a medical component. The study says many individuals prefer not to have dental insurance and choose not to visit the clinic even for necessary treatments. Dental treatments involve a lot of expenses, even after the procedure exclusions, maximums, and co-pays. Patients feel stuck with payments, even after the insurance coverage. Outsourcing to Capline Dental Services, being in the market, and satisfying clients guarantees quick reimbursement.
Cross-coding strengthens patient care and trust. It ensures patient coverage and lowers out-of-pocket costs, making dental care more attainable. Additionally, providers have the advantage of consistent cash flow, improved RCM, and timely reimbursements. Cross-coding is methodical, especially for procedures involving oral surgeries, injuries, and infections, where wrong coding is a costly outcome.
Many dentists submit medical insurance as a medical necessity. A medical necessity procedure is when it aligns with medical quality for diagnosis, treatment, prevention, development of the condition, and rehabilitation.
Below are the dental services that fall under dental-to-medical cross-coding.
Incision and Drainage of Abscess
D7510- Oral mucosa (inflammation, pain, and sepsis), clinical lancing.
CPT-41800 abides by clinical lancing combined with surgery and periodontal diseases.
Tooth Extraction
D7140- The dental code for the exposed or erupted tooth extraction (depending on infection or injury), the CPT code 41899 unlisted procedure, dentoalveolar structures, or 41820 excision of intraoral soft tissue lesion.
Biopsy of Oral Tissue
D7285- biopsy of the oral sample.
CPT-41100 microscopic examination of the front one-third.
CPT- 40808 biopsies of the oral vestibule to assess injury or possible malignancies.
Surgical Intervention of Impacted Tooth
D7240- the surgical removal of an impacted tooth through incising gums, removing bone, and then tooth extraction.
CPT-41899 unlisted procedure, dentoalveolar structures.
CPT-21248 abides by the upper and lower jaw reconstruction for structure.
Oral Evaluation
D0150, D0140, and D0120 can bill to medical insurance as 99202 and 99205 for the patients who came first to experience the service, and 99211 and 99215 for present patients receiving ongoing care.
Cone Beam CT and TMJ Series Interpretation
D0368 can be billed to medical insurance for CBCT 70486 CT scan, maxilla, and mandible without contrast material. 76497 as a diagnostic intervention for the scan procedure. 76102 for imaging services, complex motion for hypocycloids such as mastoid, and CT scans. D0220- periapical x-ray CPT coding to 70300 as radiologic examination, teeth, one-sided.
Cross-coding demands vigilant documentation, a solid grasp of necessary procedures, and proficiency in navigating dental and medical coding systems. By mastering these aspects, dental practices can significantly enhance their reimbursement outcomes and expand patient access to care. To optimize the billing practices or have inquiries about specific codes, contact Capline Dental Services.
Each billing has separate claim forms, and inaccuracies can delay payments, resubmission on appeal, and open up legal penalties.
Diagnostic and therapeutic procedures start with the dentist selecting ICD-10 codes (Injury to Mouth, Fractured tooth, Jaw pain) and CPT codes (NP, detailed exam, Diagnostic maxillofacial CT scan, x-ray) and supporting documentation.
Dental Insurance Billing involves evaluation, diagnostic services, and interim removable prosthodontics, where dentists list CDT codes. ICD-10 codes are optional (e.g., Injury to Mouth, initial encounter, Fractured tooth, Jaw pain). CDT codes used may include comprehensive oral evaluation, Cone Beam CT, Intraoral Periapical, and Interim partial denture, supported by accurate documentation.
