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What do dental coders do?
Dental coders review clinical documentation and ensure that appropriate CDT®, CPT®, ICD-10-CM, and HCPCS Level II codes are assigned to all billable services performed by the dentist.
What do dental billers do?
Dental billers are responsible for creating claims based on the provided codes, submitting claims to the insurance company, and following up on claims to make sure the practice receives the correct reimbursement for dental services rendered.
Both dental billers and coders need to understand the difference in submission and processing guidelines between respective insurance companies (i.e. dental carriers vs. medical carriers and commercial payers vs. government payers).
What does CDT stand for?
CDT® stands for Current Dental Terminology. In August 2000, CDT® was designated by the federal government as the national code set for reporting dental services on claims submitted to third-party payers, in accordance with authority granted by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
The American Dental Association (ADA) created the CDT® code set and, as the owner of the copyright to CDT®, makes all decisions regarding dental code revisions, deletions, and additions. The ADA updates the code set annually.
Payment from third-party payers to dental providers is based on CDT® codes and reported on the 2019 ADA claim form. Reported codes must be current to maintain compliance with HIPAA and to receive reimbursement.
Do dental claims require ICD-10 diagnosis codes?
Not all dental insurance carriers require ICD-10-CM codes. An increasing number of dental payers, including Medicaid dental programs, are requiring diagnosis codes on claims, however.
Do you need ICD-10-CM training to work as a medical coder and biller for a dental practice?
Reporting ICD-10-CM codes appropriately requires knowledge of ICD-10-CM coding. Dental coders must understand all coding guidelines, in addition to the conventions to select diagnosis codes accurately.
Among more than 73,000 codes in the ICD-10-CM code book, roughly 750 directly apply to dentistry. These codes provide the ability to capture descriptive information for various types of patient encounters and clinical conditions.
What is cross coding?
Cross coding is a term for billing medical insurance for dental services. A patient can have dental services, diagnosed as medically necessary, billed to their medical insurance plan. With medical carriers increasing their dental related coverages, cross coding and billing for dental services is becoming commonplace.
Coding and billing staff should be trained in medical and dental coding. A biller cannot effectively appeal denials without a working knowledge of CDT®, CPT®, ICD-10-CM, and HCPCS Level II guidelines. Additionally, understanding bundling issues and knowledge of proper documentation requirements are essential to ensure billing compliance.
What are the areas of specialty in dentistry?
- Dental Public Health: Dental public health works to prevent and control dental diseases while promoting dental health through public advocacy.
- Endodontics: Endodontics is the diagnosis, prevention, and treatment of conditions of the human dental pulp and periradicular tissues.
- Oral and Maxillofacial Pathology: Oral pathology is the identification, diagnosis, and management of diseases affecting the oral and maxillofacial regions. This specialty researches oral disease etiology, pathophysiology, and treatment outcomes
- Oral and Maxillofacial Radiology: Oral and maxillofacial radiology is the discipline of radiology ordering and interpretation of radiologic images for the diagnosis and treatment of diseases in the oral region.
- Oral and Maxillofacial Surgery: Oral and maxillofacial surgery involves diagnosis, surgical treatment of diseases, injuries, and defects of the hard and soft tissues of the oral and maxillofacial region.
- Orthodontics and Dentofacial Orthopedics: Orthodontics and dentofacial orthopedics includes the diagnosis, prevention and modification of malocclusions, neuromuscular, and skeletal abnormalities of the orofacial structures.
- Pediatric Dentistry: Pediatric Dentistry provides both primary and comprehensive preventive and therapeutic oral healthcare for infants through adolescence.
- Periodontics: Periodontics includes the health, maintenance, prevention, diagnosis, and treatment of diseases of the supporting structures and surrounding tissues in the oral region.
- Prosthodontics: Prosthodontics pertains to diagnosis, treatment, rehabilitation, and maintenance associated with missing or deficient teeth and oral and maxillofacial tissues using dental prosthesis.