Strategies to Overcome Key Dental Billing and Coding Challenges

Hello and welcome to our podcast series. My name is Meghann Drella and I’m a Senior Solutions Manager here at Outsource Strategies International. Today, I’ll be discussing how to overcome key challenges in dental billing and coding.

In today’s healthcare environment, dental practices face various billing and coding challenges. CDT codes are subject to frequent changes which are not always easy to understand. Billing dental procedures and getting claims approved can be quite taxing.

00:28 Common Coding and Claim Submission Challenges

Common coding and claim submission challenges facing dental practices are –

•  Changing CDT code: CDT codes are updated annually in order to accommodate new technologies and materials, and procedures, which can promote earlier oral disease diagnosis and treatment, and improve patients’ health. For instance, as of January 1, 2020, there are 37 new codes, five revised codes, and six deleted codes.

Please see the attached article for the listing of all these codes.

• Periodontal category descriptor revisions (site)
  • If two contiguous teeth have areas of soft tissue recession, each area of recession tooth is a single site.
  • Depending on the dimensions of the defect, up to two contiguous edentulous tooth positions may be considered a single site.
• Troublesome CDT procedure codes: According to a 2018 report, a study reported the most troublesome procedures as: Periodontal scaling and root planing, Crown-porcelain/ceramic substrate, and Core buildup.

These codes require the most supporting documentation for adjudication and are most often rejected at the first submission.

• No CDT code to accurately describe services provided: According to the ADA Center for Professional Success, while the annual CDT code update helps keep procedures and documentation in step, dentists may find that there is no CDT code for a particular procedure they are providing. This occurs when delivery of new or modified dental procedures and the CDT Code maintenance process are not synchronized. In this situation, the ADA recommends that an “unspecified …procedure by report” CDT code may be considered, such as “D2999 unspecified restorative procedure, by report”. “By report” procedure codes must be accompanied by documentation that describes the service provided. Providers can also use this opportunity to fill the gap by submitting a CDT Code action request. However, it can take almost three years for a code to go through the entire review, approval and implementation process.

• Adverse claim decisions by third party payers: There are coverage limitations and exclusions provisions in dental benefit plan documents, such as frequency limitations, date of service restrictions, least expensive alternative treatment provisions and other policies. Policy-based denials are difficult to overcome. Other reasons for claim denials and delays include using incorrect codes or not submitting supporting documents such as radiographs and other information.

02:57 Dental Billing and Coding Best Practices

 Failing to use accurate CDT codes in documentation will cause payment delays and denials and also increase fraud risk. Here are some best practices from the Academy of General Dentistry (AGD) to ensure effective coding and accurate claim submission, and reduce risk of denials and allegations of fraud:

• Use the most precise and up-to-date code to reflect the procedure performed. The CDT Code that is valid on the date of service should be reported.
• Submit supporting documentation such as narratives and radiographs. Diagnostic radiographs must have the patient’s name and the date on which they were taken. Periodontal treatment determinations generally require charting and radiographs. Narratives should be clear and concise, and state the diagnosis and reason why the procedure was performed.
• Ensure that the patient’s personal information is entered correctly – birth date, Social Security number, and insurance policy and group numbers.
• If a claim is denied for lack of dental “necessity” or “appropriateness,” even if all the required information and documentation have been submitted, file an appeal as articulated in the explanation of benefits (EOB). Language from the code’s nomenclature and/or descriptor in the CDT Code should be used to file the claim and explain why the services provided were necessary or appropriate.

I hope this helps, but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for joining me and stay tuned for my next podcast.