Overcome Important Challenges in Dental Insurance Billing Code

In the present’s healthcare environment, dental practices encounter multiple coding and billing challenges. CDT dental insurance billing code is subject to changes often which are always not easy to comprehend. Billing the dental procedures and availing claims accepted can also be very taxing.

Dental procedures submission to the medical plan of a patient or medical dental billing can be even very complicated. Practices can depend on outsourced dental billing services to defeat these challenges, but they must be fully aware of the common coding and billing pain points that can impact their bottom line.

Common Claim Submission and Coding Challenges Confronting Dental Practices

Modifying CDT code: CDT codes are annually updated to reside the latest materials, procedures, and the technologies which can earlier promote oral disease treatment and diagnosis, and enhance patients’ health. For example, as of January 1, 2020, there are five revised codes, six deleted codes, and 37 new codes. Here are few of these modifications:

 Revised codes

D1520 space maintainer – unilateral, – per quadrant- removable

D1510 space maintainer –unilateral – per quadrant, fixed, Excludes a distal shoe space maintainer

D1575 distal shoe space maintainer –– unilateral – fixed- per quadrant fabrication

If 2 teeth contiguous have areas of soft tissue recession, every area of recession tooth is a single site.

Based on the dimensions of the defect, up to 2 contiguous edentulous tooth positions might be considered a single site.

Deleted codes

• D8694 Repair of retainers fixed comprises reattachment
• D8691 Repair of appliance orthodontic
• D1550 Rebond or recement space maintainer
• D1555 Fixed space maintainer removal
• D8692 Lost or broken retainer replacement
• D8693 Rebond or recement fixed retainer
• Troublesome codes of CDT procedure: As per 2018 www.dentistryiq.com report, a study described the highly troublesome procedures as:
• D2950: Core buildup, comprising any pins when needed
• D4341: Periodontal root planning and scaling, per quadrant, is discussed as comprising “instrumentation of the root surfaces and crown of the teeth to eliminate calculus and plaque from these surfaces.”
• D2740: Crown- ceramic substrate/porcelain
• These codes need highly supporting documentation for adjudication and are very frequently rejected at the submission first.

New codes

• D9997 Dental case management, patients with special health-care requirements
• D2753 Titanium, titanium alloys, or Crown
• D0419 Assessment of flow salivary by measurement
• D5284 Removable partial unilateral denture, one-piece flexible base (comprising teeth and clasps), per quadrant
• D5286 Removable partial unilateral denture, one-piece resin (comprising teeth and clasps), per quadrant
• D6082 Implant-supported crown; porcelain fused to predominantly alloys base
• D6083 Implant-supported crown; porcelain fused to noble alloys
• D6084 Implant-supported crown, porcelain fused to titanium or titanium alloys
• D6086 Implant-supported crown, predominantly base alloys
• D6087 Implant-supported crown, noble alloys
• D6088 Implant-supported crown, titanium or titanium alloys
• D6120 Implant-supported retainer, porcelain fused to titanium and titanium alloys
• D6121 Implant-supported retainer for metal FPD, predominantly base alloys
• D6123 Implant-supported retainer for metal FPD, titanium and titanium alloys
• D6195 Abutment supported retainer, porcelain fused to titanium and titanium alloys
• D6243 Pontic, porcelain fused to titanium and titanium alloys
• D6753 Retainer crown, porcelain fused to titanium and titanium alloys
• D6784 Retainer crown 3/4, titanium and titanium alloys
• D7922 Placement of intrasocket biological dressing to assist in clot or hemostasis stabilization, per site

No CDT code to correctly discuss service offered: As per the ADA Center for Professional Success, while the yearly CDT code update assists keep documentation and procedures in step, dentists might discover that there is no CDT code for a specific procedure they are giving. This arises when delivery of modified or new dental procedures and the CDT Code process pf maintenance are not synchronized.

In this instance, the ADA suggests that an “unspecified …process via report” CDT code might be considered, like the “D2999 unspecified restorative procedure, via report”. “By report” procedure codes should be accompanied by documentation that mentions the provided services.

Dental Insurance Billing Code

Providers can deploy this chance to fill the gap by submitting a CDT dental insurance billing Code action request. However, it can take around 3 years for a code to go via the whole approval, implementation, and review process.

Adverse decisions of the claim by payers third party: There are coverage restrictions and provisions exclusions in dental advantage plan documents, like the date of service restrictions, frequency limitations, least costly alternative treatment policies and other provisions.

 Policy-based denials are tough to defeat. Other causes for claim delays and denials comprise deploying wrong codes or not submitting documents supporting like the radiographs and other data.

Dental Insurance Billing Code

Failing to deploy correct CDT codes in documentation will create delays in payment and denials and also increase the risk of fraud. Here are some excellent practices from the AGD (Academy of General Dentistry) to make sure efficient coding and correct submission of the claim, and decrease the risk of denials and fraud allegations:

Deploy the highly precise and up-to-date code to mirror the performed procedure. The CDT Code that is valid on the service date must be reported.

Submit documentation supporting the radiographs and narratives. Diagnostic radiographs should have the name of the patient and the date on which they were taken. Claims for treated teeth with crowns or on lays should comprise periapical pictures.

Periodontal determinations treatment generally needs radiographs and charting. Narratives must be concise and clear and state the reason and diagnosis of why the procedure was done.

Make sure that the patient’s details are correctly entered such as date of birth, Social Security number, group numbers, and insurance policy number.

If a claim is rejected for lack of dental “appropriateness, or necessity” even if all the information required and documentation submitted have been, file an appeal as given in the (EOB) explanation of benefits. Language from the nomenclature of codes or/and descriptors in the CDT Code must be deployed to file the claim and clarify why the services provided were appropriate or essential.

With all these distinct challenges, most practices are opting to outsource their dental coding and billing tasks. With AAPC-certified coders who informed about dentalinsurance billing code modifications and payer guidelines, an experienced dental billing organization like DentalRCM can assist providers to submit issue-free claims and make sure optimal payment.

Established dental billing companies also give dental insurance verification and pre-authorization services, comprising patient enrollment, and registration.

For more information you can visit our official website and contact with tool free at +1 8883152050