Dental Billing and Coding: Get Paid for Every Procedure

Denials in dentistry are not related to the quality of care. Denials occur due to an outdated code, lack of an X-ray, or the frequency limit that was not verified. Precise coding and billing distinguish a dental practice that successfully collects what is owed from the one that constantly deals with appeals. Exact Core Group assists dental practices in submitting accurate claims.

There is no such thing as medical insurance with dental coverage. Dentistry uses its own coding system, claim form, and benefit structure.

Dentists use CDT codes, which are updated annually by the American Dental Association. D0120 refers to periodic examination, D1110 – adult prophylaxis, and scaling and root planning is done by D4341/D4342 (based on the number of quadrants). Submission of outdated code is one of the most frequent mistakes in dentistry.

Almost all dental insurance policies set annual maximums, limit cleanings and x-rays, and have waiting periods for major procedures.Many of these plans only cover a reduced cost alternative procedure. Not checking benefit limitations prior to treatment means the practice provides a procedure partially covered by the plan.

Most denials are made for the same small number of mistakes:

• Using outdated or wrong CDT codes
• Not including X-rays, narratives or periodontal charting
• Performing procedures in excess of plan frequency limits
• Procedure done before verifying eligibility
• Submitting claims past the plan filing deadline

This is an easy process that helps to see what benefit coverage is left, restrictions and waiting periods of plans and gives you the opportunity to give your patient an accurate cost prediction.

Thorough notation, including tooth numbers, surfaces, and pictures, will increase the chances of your claim being approved and easily defended should documentation be requested from you.

Some procedures, such as surgical intervention associated with a medical diagnosis or treatment of injury, can be billed under the medical plan and not the dental one. This means knowing about medical insurance and billing, since medical claims are made using CPT and ICD-10 codes instead of CDT. Whether to submit to medical or to dental depends on the procedure and insurance of your patient.

It is possible that there could be some practices that will be able to manage their medical billing and coding through a program in house. It is possible that this method will work, although there are some factors like time required for training and updating code sets and payers’ requirements that may hinder the process. There are some practices that prefer to outsource the process to a

team of specialists who would handle claim submission, denials, and processing. The decision on which route to take will depend on the size and time of your practice.

The dental coding is carried out using CDT coding and the ADA claim form. Medical coding uses the CPT and ICD-10 coding.

Yes, depending on what is being done, it can.

Yes, Exact Core Group serves both solo practitioners and multi-practitioner dental practices.

For those of you who may be wondering, the only way to know is with a billing audit. Contact Exact Core Group to see why there are delays in your claim payments, reduced payments, and rejections.