Medical billing for dental offices and the 2017 CDT updates: What you need to know

Do you bill medical insurance for medically necessary dental procedures performed in your office? If you do, it’s important to understand the changes to the CDT codes for 2017. When you find yourself using some of these new codes, it might be a sign that you should consider billing medical insurance for a specific procedure.

For many of your patients, medical insurance may provide better coverage and lower out-of-pocket expenses than their dental coverage for the same procedure. By helping patients receive proper insurance coverage for necessary treatments, you ensure that they can adhere to a treatment plan and restore their health.

Here is a selection of new codes and how they relate to medically necessary treatments.

• D0414—Laboratory processing of microbial specimen to include culture and sensitivity studies, preparation, and transmission of written report.
This code relates to microbial specimens. If you’re using it, you’re probably diagnosing an infection. That means that the lab processing may be covered by a patient’s medical insurance. Remember to check which labs are covered by your patient’s insurer.

• D0600—Non ionizing diagnostic procedure capable of quantifying, monitoring, and recording changes in structure and enamel, dentin, and cementum.
Procedures covered by this code could be eligible for medical billing if the structural changes are related to a medical condition such as GERD or bulimia or the side-effects of certain medications. If you need to monitor changes to structure, enamel, dentin, and cementum, make sure you’ve taken a complete medical history of the patient. The underlying causes of the changes to the teeth are what determine whether this diagnostic procedure is medical or purely dental.

• D4346—The removal of plaque, calculus, and stains from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indicated for patients who have swollen, inflamed gingival and generalized suprabony pockets, in moderate to severe bleeding on probing. This should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.

Inflammation is a recognized medical condition, and treating gingival inflammation is especially important when patients have diabetes or heart disease. Because this procedure can treat a condition caused by these systemic diseases, it may be eligible for medical billing. Remember, check with a patient’s insurance before you make any statements about which treatments will and will not be covered by medical rather than dental insurance. Keep in mind that for gingival inflammation, medical insurance may cover more extensive treatment and more treatments over time than traditional dental insurance.

D9311—Treating dentist consults with a medical health care concerning medical issues that may affect patient’s plan dental treatment.
This code represents clear acknowledgement of the oral-systemic health link. It’s meant to cover consultations with a patient’s primary care provider and other specialists. For instance, when you’re treating a patient with diabetes, you might want to collaborate with the person’s primary care physician on issues related to blood sugar control, medications, diet, and exercise. Since diabetes affects the gums and the gums affect diabetes management, these medical consultations can greatly improve a patient’s overall health and well-being. Using this code generally indicates that you’re treating a systemic medical condition with oral effects rather than a purely dental condition.

D9993—Patient-centered, personalized counseling using methods such as motivational interviewing to identify and modify behaviors interfering with positive oral health outcomes. This is a separate service from traditional nutritional or tobacco counseling.

D9991—Individualized efforts to assist patients to maintain scheduled appointments by solving transportation challenges or other barriers.
This was put into effect to cover Medicaid patients so they do not miss appointments, and then show up in pain.

D9992—Assisting in a patient’s decision regarding the coordination of oral health care services across multiple providers, provider types, specialty areas of treatment, health care settings, health care organizations, and payment systems.
This code is used to explain the additional time and resources used to provide experience or expertise beyond that possessed by the patient.

D9994—Individual, customized communication of information to assist a patient in making appropriate health decisions designed to improve oral health literacy.
It should be explained in a manner acknowledging economic circumstances and different cultural beliefs, values, attitudes, traditions, and language preferences, and adopting information and services to these differences. This requires the expenditure of time and resources beyond that of an oral evaluation or case presentation. For example, patients from another country or who believe that fluoride or any medication is not necessary may require more time and explanation. We need to be able to communicate benefits and medical needs.

With regard to dental implants, D6081 is a procedure no longer performed in conjunction with D1110 or D4910.

D6085 is used when a period of healing is necessary prior to fabrication and placement of permanent prosthetic.
While a patient is healing, use this code when they come in for their follow-up.
Revised codes and medical cross-coding

This year’s last chapter contains all the codes that underwent a revision in the description of the code. A change or deletion of a word can change the meaning.

A sample of how a revision can change your sedation coding: Last year, CDT Code D9248’s nomenclature was revised from “nonintravenous conscious sedation” to “nonintravenous moderate (conscious) sedation.”

Many of the revised codes also have bearing on medical cross-coding. For instance, there have been many revisions to the codes for oral and maxillofacial surgery. These procedures often come into play after traumatic injuries and are therefore often covered by medical insurance. In other cases, these surgical procedures are necessary to restore normal function in a patient. Recently revised surgical codes include D7140, D7210, D7250, and D7280.

Since these procedures make it possible for people with oral and facial injuries to eat, talk, and breathe normally again, they might be covered by a patient’s medical insurance. In many cases, the low caps on dental insurance benefits mean that a patient with severe facial injuries will be better off financially if your office bills through medical insurance rather than dental insurance.

Finally, overused codes such as D0140 and D9110 can be swapped out for codes that instead show what you are doing, not why you are doing it.
Updating your billing procedures to reflect the new codes

These new codes go into effect in 2017, so now is the time to train your dental staff to use them. Remember, it’s not just your billing staff who need to understand changes to codes. All clinical staff should receive training so that they can identify situations when the new codes might apply, understand when it’s necessary to gather more information on medical conditions related to a procedure, and document procedures fully so that they can be eligible for medical billing whenever possible.

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Photo courtesy of: Dentistry IQ

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