Maximising Insurance Reimbursements With Proper CDT Code Usage

Navigating CDT codes for dental billing is more of a strategic game than an obstacle. Mastering it ensures error-free claims and positions the practice for success. Common CDT coding mistakes encourage costly setbacks that affect revenue cycle efficiency. Let's dive into the essentials by Capline Dental Services to empower the practice to optimize dental billing and coding so that the practitioner can concentrate on delivering patient care.

What is Dental Coding?

Dental coding converts clinical procedures into standardized codes recognized in the industry. That allows for clear procedures in patient records, communication with insurers, and documentation of services provided. Utilizing correct CDT codes ensures accurate records and billing, facilitates timely payments, and minimizes the risk of misunderstandings with insurers.

Why do CDT Codes for Dental Billing Matter?

Dental code is the backbone of dentistry, forming an efficient RCM. Coding mistakes can lead to claim denials, delayed payments, and financial setbacks that compromise the practice's cash flow. Dental coding is more like the language of the insurance company. If the practice does not speak the same language as the insurer, the communication is affected, resulting in unresolved payments. Capline Services can help the practice keep up with the correct CDT codes and apply them for accurate payments.

Challenges in CDT codes for dental billing:

• Trivial errors such as misspelled names and incorrect patient details can have serious repercussions, including delayed payments and claim denials.
• There is a shift from old fluoride codes to updated ones- D1208 and D1206. The practices are still using outdated codes that lead to losses in reimbursement.
• Misapplication of emergency codes and underutilization of palliative treatment codes result in decreased reimbursement.
• Upcoding for a more expensive or less expensive procedure can lead to hefty penalties or legal repercussions.
• Misusing CDT codes is a frequent concern in dental billing, and improper information about dental usage can result in denials or underpayments.
• ADA (The American Dental Association) revises the codes annually, so continuing the outdated ones can lead to unnecessary rejections and undermine financial stability.

How do we minimize errors in CDT codes for dental billing?

• Regularly reviewing and staying updated about the latest coding guidelines ensures precise coding and billing.
• Dental billing software can pick the current procedure codes to streamline the coding process,  thereby reducing errors.
• The review process to identify inaccuracies before submitting claims reduces the chances of claim denials and delays.
• Continuous training commits the teams to billing and coding and makes them well-versed in the guidelines and best practices for each insurer.
• Subscribing to ADA publications and attending webinars can provide valuable insights and keep them updated about the annual updates to CDT codes.
• Clear documentation confirms specific codes of every procedure.
• Ethical coding practices among the staff save the practice from legal consequences.

Strategies for Maximum Reimbursement
Strategy 1: Detailed Documentation

To optimize the utilization of CDT codes, staff training about a thorough understanding of codes and their significance is non-negotiable. Additionally, emphasizing the documentation for reimbursement is essential.

The clinical documentation consists of these key types to focus on:

• Chart notes
• Radiographs and photos
• Periodontal/tooth charting
• Narratives

To include the documentation templates during data collection, equip the staff with the necessary tools such as:

SOAP Notes 

Subjective- Record the patient's illness, location, chief complaint, history, and severity. Objective- Document examination findings and update about the health history and vital signs. Assessment- Outline the state of diagnosis and the reasoning behind it.

Plan- Mention the treatment strategy and address any recent concerns.

PARQ 

Procedure- Explanation about the treatment to the patient.

Alternative- Providing treatment options with the potential outcomes and consequences of refusing treatment.

Risks- Providing knowledge about the associated risk with each treatment option and the risk of not opting for the procedure.

Questions- Record the patient's inquiries and responses.

Misapplying a code increases the chances of claim denials, delayed payments, and audits. Proper CDT codes offer structured documentation when collecting 100% of what is needed.

Strategy 2: Outsourcing to Capline Dental Services

To have an in-house team that is well-versed in dental coding and billing is an ideal situation. However, the constant evolution of insurance requirements is challenging to the extent of outsourcing dental billing as a step for the team.

With Capline Dental Services' resources, the practice can significantly increase revenue and streamline operations, which maximizes the finances and brings stability to the practice. Capline ensures the following:

• Current coding to reduce claim denials.
• Optimizing the Billing process for better efficiency.
• Maintain compliance with legal regulations as per the standards.
• Maximise reimbursement and help the practice to thrive.

Strategy 3: Code Resources

The ADA classifies CDT into 13 essential service areas, each designed for specific aspects of dental care. A thorough understanding of the same ensures maximum reimbursement.

Diagnostic
Diagnostic codes cover evaluations to radiographs for treatment planning.

Preventive
Preventive codes include services like cleanings and fluoride treatments to ensure optimal oral health.

Restorative
Restorative codes are resolute to fillings, crowns, and repairs for decayed or damaged teeth.

Endodontics
Endodontics codes relate to tooth pulp issues and root canal procedures in saving teeth.

Periodontics
Periodontal codes look forward to treatments for gum health, scaling, and surgical interventions.

Prosthodontics, Removable
The codes cover dentures and partials for tooth replacement solutions.

Maxillofacial Prosthodontics
The category focuses on prosthetics for the maxillofacial region and facial structure rehabilitation.

Implant Services
Implant codes help place and restore dental implants for missing teeth.

Prosthodontics, Fixed
Fixed prosthodontic codes fix bridges and crowns, offering permanent solutions.

Maxillofacial & Oral Surgery
Surgical codes include extractions and biopsies treating jaw and mouth conditions.

Orthodontics
The codes include braces and corrective procedures enhancing the teeth and jaw alignment.

Adjunctive General Services
The category captures services like anesthesia to office visits, ensuring comprehensive care.

Sleep Apnea Services
The category introduces codes for crafting and adjusting appliances for sleep apnea treatment, elevating the standard of dental practice.

Common CDT Coding Mistakes 

Every practice faces challenges with dental coding, so you are not alone.  

• Coding Errors- Small mistakes can result in significant losses, leaving money on the table. Solution- Update the billing and coding resources and equip them with updated knowledge to be on track.  
• Inconsistent Documentation- The discrepancy between the codes and the supporting documentation can result in denials. Solution- Create an SOP(Standard Operating Procedure) for the documentation to ensure consistency and accuracy. 
• Verification issues- Insurance details keep changing, and doing manual verification can lead to overlooked errors. Solution- Automate the eligibility process to eliminate errors and prevent delays. 
• Inefficient Workflows- Managing manual claims and payments can increase the chances of errors. Solution- Automating tasks like payment postings and claim submissions can optimize the workflow. 
• Insufficient training- Coding guidelines keep evolving, and a team without regular training can miss updates and impact practice revenue. Solution- Investing in staff regular training saves a lot of time and resources and keeps the team knowledgeable about the updates.