Dental codes are a challenge for any dental practice, and a thorough understanding of them is important. Dental coding accuracy is key from a billing and reimbursement point of view. CDT codes ensure a high level of standardization in dental care nationwide and are used by practices to describe the procedures and treatments offered to patients.
These codes use a series of alphanumeric codes that help to identify the precise treatments and procedures offered.
These codes incorporate a vast selection of dental procedures typically offered by a practice. It can range from regular check-ups and cleanings to elaborate procedures such as dental implants and root canals and dental implants.
To understand the impact of dental coding accuracy, we need to review how the revenue cycle pipeline in a practice works. CDT codes are not just to be factored into billing and claims submission. It even has a major role in the dental practice revenue cycle as well. Usage of accurate dental codes can positively affect the financial health and revenue cycle from the time a patient receives a treatment recommendation to the time the claim is submitted to the insurance company.
The usage of CDT codes in the USA was standardized in 2000 as a national terminology for reporting all treatments and procedures to insurance companies. Hence, for any claim that needs to be cleared by an insurance company, it needs to have precise and valid CDT codes based on the prevailing CDT guidelines. A reliable CDT Code Guide helps practices ensure accuracy and compliance when selecting the right codes for claims.
Multiple parties use CDT codes. When a patient has received treatment, the dental team has to document all the details of the procedures and services rendered. The team assigns the relevant codes for all procedures, and the same is shared with other teams and providers as required.
An in-depth awareness of coding and billing is key for any practice. They play an important role in getting reimbursement from insurance companies and in revenue cycle management. If the practice is not adequately staffed with knowledgeable team members, it can consider outsourcing billing and collections to an outsourced specialist.
For claims to be successfully processed, the usage of accurate CDT codes is vital. Applying the few steps mentioned below can help lower coding error rates for the practice.
The team needs to thoroughly understand the exact service or procedure that has been performed at the practice. This can include key elements such as the tooth number, the oral cavity area, surfaces involved, and the materials used. The dental team can find references for reviewing prevailing guidelines that can assist the team in selecting CDT codes that best describe the procedures and services performed.
CDT codes are classified into categories for easier understanding and simplicity. These sections can be termed as restorative, preventive, or diagnostic, among others. The team must grasp these categories and the components relevant to each code. The full code entry has to be verified carefully, and this includes the nomenclature and descriptor. This helps ensure that all procedures are covered with the correct codes.
There can be times when a dental procedure might require medical consideration. This would come under medical insurance from a billing point of view. Such situations call for medical and dental cross-coding. This would entail submitting dental procedure claims to a patient’s medical insurance plan and not to the dental insurance firm. Such situations need to be handled carefully, as there are guidelines to be followed when dental procedures are suggested as a medical requirement.
It is important that the dental team accurately represent CDT codes to describe the prescribed treatment offered. The dental team thus needs to be adept at billing and staying abreast of evolving codes and other regulatory guidelines. The dental team must have proper awareness of codes to be used if there is a situation of medical and dental cross-coding.
Periodic training aids the dental team in understanding the latest regulatory guidelines, the introduction of new codes, or any other changes.
The practice must insist on detailed documentation that must accompany every patient visit. This includes images, X-rays, clinical notes, etc. Such documentation helps to accurately reflect codes at the time of billing. The use of a standardized documentation template can help capture all the relevant information and documents that can then ensure error-free billing. For best results, documentation must be done immediately after the patient visit is completed.
The practice can explore purchasing any reliable coding solution that includes a solid code search functionality. The team can refer to manuals and companion guides recommended by the ADA. Additionally, the practice must implement a compliance program to monitor the billing and coding process. Periodic reviews can help identify errors, process glitches, and other issues, allowing for rectification before claim submission.
There are situations when two or more codes are billed separately instead of being billed by selecting a single inclusive code. A typical case can be a tooth extraction. The team can select the appropriate billing code that describes the procedure. In this case, local anaesthesia and suturing can be included as a regular part of a tooth extraction. This avoids the usage of two codes, which is not correct.
As outlined above, coding plays a definitive role in the success of a practice, and some of the reasons are listed below.
Coding helps to streamline insurance claims since knowledge of codes is critical to the practice and the insurance company. When wrong codes are used, claims get denied or deferred, and this creates disappointment for the patient and the practice. The use of proper codes enhances the revenue cycle.
Accurate coding helps avoid a loss in revenue. Errors in coding affect the clearance of claims and thereby the revenues of the practice. When a practice under-codes, it can lead to a loss of potential revenue, while over-coding attracts unwanted fines and negative reviews. The practice can ensure compliance and prevent legal consequences through the right selection of codes.
Patient confidence and trust must be earned by the practice, as this helps the practice to stay profitable while delivering quality care. The use of precise codes enables the team to explain the coverage based on insurance plans, and this leads to building trust with patients.
Dental coding accuracy is vital for approval by an insurance firm. It helps to receive timely reimbursement for treatment offered by the practice. Moreover, it also safeguards patient satisfaction while ensuring a healthy revenue pipeline. The correct use of CDT code in dental coding is therefore essential to avoid claim denials and maintain financial stability.
