Every year, the American Dental Association (ADA) updates its coding standards within the Current Dental Terminology (CDT) code set. For instance, as we discussed in a previous post, the 2017 changes included eleven code additions, one code deletion, and five code revisions. Several of these code changes have implications for dental-medical cross coding. It is essential to be aware of these implications, since errors in dental-medical coding can lead to claim denials and payment delays that disrupt your revenue cycle and increase your AR days.
2017 Changes with Relevance to Dental-Medical Cross Coding
There were several additions to the 2017 CDT that may affect dental-medical cross-coding processes, including the following:
a) D9311: Consultation with medical health care professional. When it comes to dental-medical cross coding, code D9311 is probably the most significant addition to the 2017 CDT. This code is used when the dentist consults with the patient’s primary care physician about a systemic condition with a broad range of health effects — including impacts on oral health. A common example is type 2 diabetes mellitus, which can negatively affect a patient’s gums.
b) D4346: Scaling in the presence of generalized moderate or severe gingival inflammation. There are a variety of possible causes of gingival inflammation, including systemic medical conditions like heart disease and diabetes. Cases in which it is possible to attribute the patient’s gingival inflammation to one of these conditions may call for dental-medical cross coding.
c) D0414: Laboratory processing of a microbial specimen. This code is almost always used in cases of infection. Depending on the nature of the patient’s infection, dental-medical cross-coding may make sense.
d) D0600: Non-ionizing diagnostic procedure capable of quantifying, monitoring, and recording changes in the structure of enamel, dentin, and cementum. There are certain medical conditions that can sometimes cause changes in the structure of enamel, dentin, or cementum. They include gastrointestinal problems, like GERD, as well as eating disorders, like bulimia nervosa. Dental-medical cross coding is warranted when a direct connection can be drawn between the structural change and an underlying medical condition.
Clearly, when it comes to dental-medical cross coding, there is ample room for error, especially considering the annual changes to the CDT. In many situations, it can be difficult to determine whether or not there is a direct connection between a medical condition and a dental condition — and if coders make the wrong choice, it can lead to major billing problems. One solution for dental providers is to outsource coding and billing to AnnexMed. Our experts are always on top of the latest CDT coding procedures, and we can help you determine when dental-medical cross coding is warranted. Contact us today to learn more about all of our services!
- Posted by admin
- On January 9, 2018
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