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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.


    Interim caries arresting medicament application

    A revised code expected to be important affects D1354, interim caries arresting medicament application. The revision puts a finer point on the code that was first introduced in 2017.

    “Codes are not product-specific,” DiGangi explains. “At this point in time, one of the products that fits under that is Silver Diamine Fluoride. It’s a product that was approved in 2014 by the FDA. It’s a caries-arresting medicament, which is different than other types of fluoride. One of the things about that code that changed is that it was through the American Academy of Pediatric Dentistry. It was used a lot in the pediatric world, and they said it needs to be a per-tooth procedure. This is where codes can really make a difference in influencing how we practice.”

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    “This is the Silver Diamine Fluoride that they’re talking about,” Sanders adds. “It was a code that allowed us to put in cavity liners and glass ionomers, but this is being very specific to clarify the nature and scope on what kind of medicaments they’re using. And in this example, they don’t necessarily say Silver Diamine Fluoride. This proposal was brought to the code maintenance committee by the American Academy of Pediatric Dentistry with the intention of, essentially, allowing Silver Diamine Fluoride to have its own, unique, special code.”

    And while codes are not product-specific, the efficacy of Silver Diamine Fluoride led to D1354’s fine-tuning.

    “The Silver Diamine Fluoride really has boomed quite a bit, I would say just in the last year-and-a-half, just because the research is so definitive on how we can help arrest decay in patients that require additional management,” Sanders says. “It’s not fun to numb up a young child, to try and get their decay to stop. So, we can just put a little liquid right on their tooth and it just stops the decay. With that trend of Silver Diamine Fluoride, it’s kind of booming in the industry. There’s been a need for that.”

    Getting ready for the new year

    While coders need to be aware of what is new in coding, there are also some best practices that improve the overall process of dental coding.

    “Bill out for the procedures that your provider did,” Sanders advises. “A lot of offices, internally, down code before they bill out. A great example is, let’s say a patient has an insurance benefit where they are a perio maintenance patient, and let’s say their benefits allow for two perio maintenances and two prophys in a calendar year. So, essentially, they’re going to get paid for two 4910s and two 1110s, and what the office will do is alternate back-and-forth — they’ll bill a 4910 and in three months a 1110, and then they’ll bill a 4910 and then a 1110. And that is really not the appropriate way to do it.

    "What they should be doing is billing out the actual service that was performed," she continues. "They should bill a 4910 and then in that narrative they can include something to the effect of, ‘Please down code as necessary,’ and that permits the insurance company to be the ones to down code and say, ‘Okay, you’ve already had two 4910s for the year, so I’m only going to pay you for these as a 1110.’ As a hygienist, that’s probably the most frustrating thing because what’s happening is we have license numbers, and it may look like we’re being negligent providers because we’re doing a prophylaxis on a periodontally involved patient. That is negligent — it’s unethical — and that’s not the procedure that was performed.”

    Staying on top of software updates is always recommended, but especially at the start of the new year.

    “At the end of the year, pay attention to any information your software sends out,” Duncan says. “You may even want to make a point of visiting their page and seeing if there have been any updates for the end of the year, and there almost always is. Software companies will push a patch through with the new codes going into effect Jan. 1, 2018. The last thing you do at the end of the year is run that update so you have the new codes for the new year.”
    It seems like something that should go without saying, but there are practices that do not update their software as recommended.

    “Computers should be updated, but offices still are not always updating their software, they’re not always updating their codes, so it’s really an interesting arena we’re working in because the majority of practices are cottage industries — they can do whatever they want within the walls of their practice, and that’s a challenge we have,” DiGangi says.

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    The end of the year is a good time to compile carrier reports, too.  While the reports can be generated any time, a year’s end compilation allows the practice to start the year with meaningful numbers.

    “We learn how much production was generated by each carrier so that we have a baseline as to how much revenue is generated from each insurance company,” Duncan says. “This is more of a historical report. And, of course, you could generate it at any time, but make sure you have a record of that information because in the coming year you may have to make a decision on participation in those networks. Ideally, you would make such decisions based on information like revenue amounts and patient counts.”

    Rather than simply reporting the procedure, DiGangi recommends coding patients’ diagnoses – especially as health records become more interdisciplinary.

    “That’s not something that we’ve done routinely in dentistry because codes have been procedure codes,” DiGangi says. “Now we’re moving very quickly toward diagnosis codes. The benefit form already has a space for diagnosis codes. Some more leading-edge offices are already using the diagnosis codes. Diagnosis codes are not something that we are used to at all in dentistry, but it is going to be required because we are moving toward interoperable electronic health records. What that means is that dentistry connects to medicine that connects to pharmacy. In order to do that, dentistry needs to be using diagnostic codes because the treatment of patients is not just about the treatment, it’s about, ‘What’s the diagnosis?’”

    Up next: Paying attention to detail

    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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