Using CDT, CPT And ICD-10 Codes – What Dental Practices Should Know

In a dental practice, understanding the numerous coding systems is vital for dental billing, insurance claims, and record maintenance. A breakdown of dental coding and systems that are prevalent is as follows.

CPT

Current Procedural Terminology or CPT is a set of important codes published and maintained by AMA or the American Medical Association that are vital for a dental practice to become familiar with.

CPT codes describe surgeries, tests, evaluations, and other procedures that are undertaken by a dental practice when treating patients. The code set is quite voluminous and incorporates codes for thousands of dental procedures.

These codes are integral to the billing process as they describe the procedures to an insurance company for which the dental practice needs to be reimbursed. They work alongside ICD codes to provide a clearer understanding of the services and procedures rendered to a patient.

The codes are divided into three categories based on the nature of the service and the solution provided. The most popular and extensively used set of codes is category 1 codes. These codes contain descriptors that correspond to services and procedures rendered. They range from 00100–99499 and consist of sub-categories depending on procedure and anatomy. They are classified into six groups such as

• Evaluation and management: 99201–99499
• Anaesthesia: 00100–01999
• Surgery: 10021–69990
• Radiology: 70010–79999
• Pathology and laboratory: 80047–89398
• Medicine: 90281–99607

CDT codes

CDT or Current Dental Terminology is a standard code set created for any dental diagnosis or procedure. It fulfills all HIPAA requirements that are needed for reporting dental procedures to other parties such as insurance companies.

Insurance companies use these codes to ascertain whether dental procedures performed on a patient are eligible for reimbursement under the existing plan.

These codes are used by the dental billing team to outline all procedures on the ADA claim form and are organized into the following 12 categories.

How are CDT codes structured:

• All codes start with the letter D and are 5-digit alphanumeric viz. the code begins with the letter D plus 4 digits.
• The nomenclature is the title of the procedure code, which may be abbreviated on the printed claim form
  Details that describe the nature and proposed use of the single procedure code. These follow the applicable procedure code and the nomenclature. It is not always needed in case the nomenclature is self-explanatory.
• The codes are dynamic and get updated annually. Such changes are a challenge for a dental practice, and it would be wise to outsource billing and claims to professionals or specialists.

ICD-10

The International Classification of Diseases or ICD codes are meant to promote a global evaluation of the collection, classification, and presentation of mortality statistics.

The ICD-10 codes are the tenth revision set of alphanumeric codes globally used to classify diseases, conditions, and medical procedures. The codes are maintained by the WHO (World Health Organization) and serve diverse objectives that encompass monitoring of diseases, billing, and research.

Every ICD-10 code comprises a series of characters that offer information about a procedure or diagnosis. The code format is alphanumeric code and gets denoted as follows:

• Letter or letters that outline the chapter or category of the disease or condition. • The number or numbers identify the disease. It could also highlight the condition within the chapter.
• A few codes may have extra characters to provide more details on the procedure or diagnosis.

From the perspective of a dental practice, these codes are significant and help in many ways.

• Dental services procedures are often covered by insurance and hence ICD-10 codes can be used to highlight the services rendered to patients during their visits. The use of precise codes helps in faster reimbursement from the insurance company.
• Using ICD-10 codes in clinical records enables the dental practice to retain an accurate track of the patient’s history. This also aids in facilitating a discussion with other healthcare providers linked to a patient's care.
• Every dental practice can participate in public health efforts by informing the authorities about specific conditions or trends using ICD-10 codes.
• Regulatory bodies demand that a dental practice follow coding standards that also include ICD-10 thus enabling them to stay compliant with legal requirements. • A dental practice can enhance patient outcomes by collating and investigating data coded with ICD-10.