The dental practice is at a crossroad with the new ICD-10 transition. Many of my clients either don’t know what to do with it or why they should even care. When I worked in a dental practice, we billed out a procedure code and got paid for it. It was pretty simple. If I was working in a dental practice now, I would be thinking more about, “Why does this patient have so much caries?” or “Why is this patient losing so many teeth?” and “What can we do to help this patient in a more holistic and whole body way?” This may be coming from my personal view of my own body. I know that if I take care of my body with better nutrition, more exercise, and a good night’s sleep, I will be healthier. But how do we convey that type of education to our patients?
The dental practice can only do so much as far as educating their patients about the benefits of nutrition, exercise, and sleep. Your patients are only in your office for a couple hours a year so we must also rely on our government and other organizations to spread the word about healthy lifestyle. How can dental practices help with this global movement in creating healthy lifestyle? You can code it properly.
When you think of your own dental practice, you might think your small, one-doctor practice might not be able to make a difference in the world. But think about this … Emdeon, which is the nation’s largest e-claim clearinghouse, processed just under 400,000 dental claims per day in 2014. Even if 50% of these claims included a proper diagnosis code, think about the data that could be added to the research and development of programs to help educate people on healthy lifestyle. We must yell out to the world how oral health affects total body health and one way we can do that is to include a proper diagnosis code.
There are 12 ICD-10 diagnosis codes to document caries. You and your clinical team are performing caries exams several times a day as part of the patient’s routine dental visit, during a new patient exam, or for a patient who comes in with a toothache. During these exams, you may be providing the patient with a value-added service with the addition of caries detection technology. These routine caries exams are part of your everyday routine, so let’s get outside of our regular routine and become the oral health physician instead of just the dentist.
The next question is “why.” Go one step further. Ask, “What kind of decay is this?” By including the proper diagnosis code on your dental claim form, you can directly help to create and substantiate programs for educating parents on how filling their baby’s bottle with sugary drinks leads to tooth rot or creating marketing campaigns to colleges around the country educating students on the effects of consuming energy drinks while they stay up to cram for finals.
It’s like starting a recycling program at your home or office. You know it is good for the earth, but learning what goes into the blue container and what goes into the garbage is a little bit of a learning curve in the beginning. If you create a system with the most common products then you, your family, and your team will catch on pretty quickly. The same thing goes for creating a system for proper coding. Discover which common procedure codes you bill out every day and what code you could attach a diagnosis code and then create a system. Create a spreadsheet or it’s even better if you can cross-code it in your practice management software with the ADA CDT code matched up with the diagnosis code options.
Once you have set the new mindset, the rest is just logistics. Double-check with your practice management software company to see if the current version of your software is ready for the new ICD-10 coding or if you will need to upgrade. After October 1, 2015, the ICD-9 codes will no longer be accepted so you will want to make sure you are ready because you do not want anything to slow down your payments. Also, the ADA2012 claim format is the most current dental claim form and it already exists for ICD-9 and ICD-10. There are many other resources to help you navigate the new world of ICD-10 and how you can code like the oral health physician you are.
Here is a great resource to look up the diagnostic codes if you want to do your own research and create a spreadsheet for your office. Go to ICD10data.com. It is a free source where you can enter a description or a code and pull up additional information and other codes associated with it. You can also look up an ICD-9 code and transition it to ICD-10. It is a great website.