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    What 2018 means for insurance coding

    What you need to know, what you can ignore and how to keep from getting into trouble.

    For those who still write paper checks, the New Year can be a tricky time. It can take several attempts before writing “2018” replaces the habit of writing “2017.”

    And the New Year poses similar challenges for the dental practice’s insurance coders. When the calendar ticked over to Jan. 1, 2018, the insurance codes from 2017 changed. While most are, of course, the same, others have been removed, some have been revised, and still others are brand-new.

    The American Dental Association’s Code Maintenance Committee decides on changes to the formal list of codes. For 2018, there are 18 new codes, 16 revised codes and three deleted codes. The Code on Dental Procedures and Nomenclature (CDT) 2018 adjustments mean fewer claims rejections and speedier reimbursement.

    Related reading: 8 ways to make insurance less of a pain

    “There are some really exciting changes that are coming up in 2018,” says Patti DiGangi, RDH, a coding consultant. “Codes are updated once a year, and what the updates give us is an opportunity for new and innovative ideas, products and procedures.”

    HbA1c testing

    Maybe the most compelling new code is D0411, which covers in-office, point-of-service HbA1c testing, a blood sugar measurement that can be an indicator for diabetes.

    “This is going to be huge,” says Katrina Sanders, RDH, a clinician and practice consultant, and member of the Modern Hygienist editorial board.

    “It’s the first time that we’re going to be able to do a blood draw in the office and be able to bill for it using a dental code.”

    Dental claim formPreviously, blood sugar testing was covered when taking a simple blood sugar reading. Now, however, more comprehensive results are billable.

    “In office, if we did do a blood draw, we just took a blood sugar reading that moment and an HbA1c gives you a survey over time,” Sanders says. “Blood sugar is just going to tell you if your diabetic patient has a low blood sugar at that moment. Maybe they had just taken their insulin and hadn’t eaten breakfast, so it just gives you a reading of, ‘Are you a risk in our office right now?’ This is the first time we are doing an HbA1c, which allows us to find a marker for patients that maybe are uncontrolled diabetics, but also for patients that have diabetes and may not know that they have it.”

    This code makes it possible for the clinician to be more involved in the patient’s overall health.

    “It’s not a diagnostic test; it’s a screening test,” DiGangi observes. “But with the epidemic of diabetes in our country, it gives dentistry an opportunity to help guide our patients and work more closely with their physicians, or even get someone to a physician who may not even know they have a problem with their blood sugar and possibly have diabetes.

    “What’s important about that code is not so much that it’s a code that’s going to make us into physicians, but it’s going to connect the oral systemic,” she continues. “We keep talking about it, but this is a really definitive way to take action. It gives them tangible reasons to follow up with their physicians.”

    Insurance professional and consultant Teresa Duncan, MS, warns, however, that HbA1c testing should be performed conscientiously.

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    “I always caution that just because there’s a code doesn’t mean you should bill it,” she advises. “You should only bill it if it’s actually being done in your office and if you’re prepared to handle the consequences of that. What I mean by that is that when you give someone a diagnosis or let them know their levels are off, that’s a serious conversation you’re about to have with that patient. Diabetes is a life-changing diagnosis.

    It’s not just a very low-effort test. We’ll need to pay attention to what and how we’re telling patients that their health status has changed.”

    Up next: Teledentistry

    Robert Elsenpeter
    Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author ...


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